Conroy Stephen, Hill Duncan
Lanarkshire Alcohol and Drug Service, Coatbridge, Scotland, UK.
NHS Lanarkshire, Motherwell, Scotland, UK.
BMJ Case Rep. 2014 Dec 17;2014:bcr2014207458. doi: 10.1136/bcr-2014-207458.
The prescribing of opioid pain medication has increased markedly in recent years, with strong opioid dispensing increasing 18-fold in Tayside, Scotland since 1995. Despite this, little data is available to quantify the problem of opioid pain medication dependence (OPD) and until recently there was little guidance on best-practice treatment. We report the case of a young mother prescribed dihydrocodeine for postoperative pain relief who became opioid dependent. When her prescription was stopped without support, she briefly used heroin to overcome her withdrawal. After re-exposure to dihydrocodeine following surgery 9 years later and treatment with methadone for dependency, she was transferred to buprenorphine/naloxone. In our clinical experience and in agreement with Department of Health and Royal College of General Practitioner guidance, buprenorphine/naloxone is the preferred opioid substitution treatment for OPD. Our patient remains within her treatment programme and has returned to work on buprenorphine 16 mg/naloxone 4 mg in conjunction with social and psychological support.
近年来，阿片类止痛药物的处方量显著增加，自1995年以来，苏格兰泰赛德地区强效阿片类药物的配药量增加了18倍。尽管如此，几乎没有数据可用于量化阿片类止痛药物依赖（OPD）问题，而且直到最近，关于最佳治疗方法的指导也很少。我们报告了一例年轻母亲的病例，她因术后疼痛缓解而被开具双氢可待因，后来对阿片类药物产生了依赖。当她在没有支持的情况下停止用药时，她短暂地使用海洛因来克服戒断反应。9年后，她在手术后再次接触双氢可待因，并接受美沙酮治疗成瘾，之后转用丁丙诺啡/纳洛酮。根据我们的临床经验，并与卫生部和皇家全科医师学院的指导意见一致，丁丙诺啡/纳洛酮是治疗OPD的首选阿片类替代疗法。我们的患者仍在治疗方案中，并在社会和心理支持下，服用丁丙诺啡16毫克/纳洛酮4毫克恢复了工作。
