Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX, 77030, USA.
Curr Treat Options Oncol. 2020 Mar 19;21(4):30. doi: 10.1007/s11864-020-0724-4.
The opioid epidemic is one of the most important public health crises as opioid-related deaths have become a leading cause of accidental death in the USA. Various efforts have been made to understand how to safely and appropriately prescribe opioids for patients with chronic pain, including those with cancer-related pain. We find the guidelines proposed by the Expert Consensus White Paper on the use of methadone to be current, comprehensive, and practical. While methadone is a complex medication with unique pharmacokinetics and pharmacodynamics, it remains a superior choice for many patients with cancer pain given its cost and applicability in a variety of situations. Methadone should be prescribed in the context of experienced clinicians as well as an interdisciplinary team. At a critical time when preventing opioid-related deaths is a priority, we recommend implementing additional precautions for monitoring including universal screening for risk of non-medical opioid use, education on proper storage and disposal, as well as discussing a plan with patients and caregivers in the case of serious complications such as opioid overdose.
阿片类药物泛滥是最重要的公共卫生危机之一，因为阿片类药物相关的死亡已经成为美国意外死亡的主要原因。为了了解如何安全、适当地为慢性疼痛患者（包括癌症相关疼痛患者）开阿片类药物处方，已经做出了各种努力。我们发现，美沙酮使用专家共识白皮书提出的指南是现行的、全面的和实用的。虽然美沙酮是一种具有独特药代动力学和药效学的复杂药物，但鉴于其成本和在各种情况下的适用性，它仍然是许多癌症疼痛患者的首选药物。美沙酮应该在有经验的临床医生以及跨学科团队的背景下开具。在预防阿片类药物相关死亡成为当务之急的关键时刻，我们建议采取额外的监测预防措施，包括对非医疗用途阿片类药物使用风险的普遍筛查、关于正确储存和处理的教育，以及在发生严重并发症（如阿片类药物过量）的情况下与患者和护理人员讨论计划。
