Rieb Launette M, Samaan Zainab, Furlan Andrea D, Rabheru Kiran, Feldman Sid, Hung Lillian, Budd George, Coleman Douglas
Department of Family Practice, University of British Columbia, Vancouver, BC.
Department of Psychiatry, McMaster University, Hamilton, ON.
Can Geriatr J. 2020 Mar 30;23(1):123-134. doi: 10.5770/cgj.23.420. eCollection 2020 Mar.
In Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors' Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.
A systematic review of English language literature from 2008-2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.
Thirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.
These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.
在加拿大，老年人（≥65岁）因阿片类药物过量导致的住院率高于年轻人，阿片类药物使用障碍（OUD）日益受到关注。作为回应，加拿大卫生部委托加拿大老年人心理健康联盟制定老年人OUD预防、筛查、评估和治疗指南。
对2008年至2018年关于成人OUD的英文文献进行系统综述。使用AGREE II对先前发布的指南进行评估，并通过借鉴当前文献，采用ADAPTE方法对关键指南进行更新。使用GRADE方法制定并评估建议。
制定了32条建议。预防建议：优先采用非药物和非阿片类策略治疗急性和慢性非癌性疼痛是关键。评估建议：全面评估有助于识别其他医疗状况的影响，这很重要。治疗建议：丁丙诺啡是戒断管理和维持治疗的一线药物，而美沙酮、缓释口服吗啡或纳曲酮在某些情况下可作为替代药物；应将非药物治疗作为护理的一个组成部分提供。
这些指南为加拿大背景下老年人OUD的预防、评估和治疗提供了实用且及时的临床建议。
