Department of Pharmacy Practice, Massachusetts General Hospital, Boston, MA.
Department of Pharmacy Practice, Duquesne University, Pittsburgh, PA.
Am J Health Syst Pharm. 2019 Jul 18;76(15):1097-1103. doi: 10.1093/ajhp/zxz105.
The use of buprenorphine, methadone, and long-acting naltrexone for treatment of opioid use disorder (OUD) is discussed, including a review of current literature detailing treatment approaches and action steps to optimize treatment in acute care and office-based settings.
The U.S. epidemic of opioid-related deaths has been driven by misuse of prescription opioids and, increasingly, illicit drugs such as heroin, fentanyl, and fentanyl analogs, necessitating a refocusing of treatment efforts on expanding access to life-saving, evidence-based OUD pharmacotherapy. Inpatient treatment of opioid withdrawal includes acute symptom control through a combination of nonopioid medications and long-term pharmacotherapy to lessen opioid craving and facilitate stabilization and recovery. Methadone and buprenorphine reduce opioid craving, increase treatment retention, reduce illicit opioid use, and increase overall survival. Buprenorphine has logistical advantages over methadone, such as greater flexibility of treatment setting and less risk of adverse effects. Studies have shown the efficacy of long-acting injectable naltrexone to be comparable to that of buprenorphine if patients are detoxified prior to initiation of therapy; however, patients with active OUD are often not able to complete the week-long period of opioid abstinence needed prior to initiation of naltrexone injections. Although buprenorphine is preferred by many patients and can be prescribed in office-based settings, there remains a paucity of physicians certified to prescribe it.
Buprenorphine has become the medication of choice for many patients with OUD, but its use is limited by the low number of physicians certified to prescribe the agent. Other agents studied for treatment of OUD include methadone and naltrexone.
讨论丁丙诺啡、美沙酮和长效纳曲酮治疗阿片类药物使用障碍（OUD）的应用，包括对当前文献的综述，详细介绍了优化急性护理和门诊环境中治疗的方法和步骤。
美国的阿片类药物相关死亡人数呈上升趋势，这主要是由于处方阿片类药物的滥用，以及越来越多的非法药物如海洛因、芬太尼和芬太尼类似物的使用所致，这使得治疗工作的重点需要重新放在扩大获得救命的、基于证据的 OUD 药物治疗的机会上。阿片类药物戒断的住院治疗包括通过非阿片类药物和长期药物治疗相结合来控制急性症状，以减轻阿片类药物的渴求，促进稳定和康复。美沙酮和丁丙诺啡可减少阿片类药物的渴求，增加治疗保留率，减少非法阿片类药物的使用，并提高总体生存率。丁丙诺啡与美沙酮相比具有更大的治疗设置灵活性和更小的不良反应风险等优势。研究表明，对于已接受脱毒治疗的患者，长效注射用纳曲酮的疗效与丁丙诺啡相当；然而，患有活动性 OUD 的患者通常无法完成开始纳曲酮注射前需要的一周的阿片类药物戒断期。尽管许多患者更喜欢丁丙诺啡，并且可以在门诊环境中开处方，但能够开具该药物的医生数量仍然很少。
丁丙诺啡已成为许多 OUD 患者的首选药物，但由于能够开具该药物的医生数量较少，其使用受到限制。其他用于治疗 OUD 的药物包括美沙酮和纳曲酮。
