MBBS, FRACP, FAChAM, Addiction Medicine Specialist, Western Health and Melbourne Health, Vic.
MBBS, FAChAM, Clinical Director, Turning Point, Vic.
Aust J Gen Pract. 2020 Jun;49(6):339-343. doi: 10.31128/AJGP-07-19-4994.
Opioids are frequently used to manage chronic non-cancer pain despite the lack of evidence of benefit and clear evidence of opioid-related harms. Patients undergoing high-dose opioid therapy are at risk of multiple complications, such as opioid toxicity, including fatal overdose and opioid dependence.
This article provides an overview of the pharmacology of buprenorphine and reviews current evidence for the use of high-dose sublingual buprenorphine-naloxone in the pharmacological management of patients at high risk of complications from chronic opioid use.
Buprenorphine-naloxone is well tolerated by patients with chronic pain, and has the potential to improve pain scores and affective symptoms. This is exemplified in a case study based on these authors' experience in an addiction medicine setting. As the rates of pharmaceutical opioid prescribing and related harms continue to increase in Australia, buprenorphine-naloxone is a viable option to manage high-risk chronic pain patients who are unable to reduce or cease their opioid use.
尽管缺乏益处的证据和明确的阿片类药物相关危害的证据，但阿片类药物仍常被用于治疗慢性非癌痛。接受高剂量阿片类药物治疗的患者存在多种并发症的风险，如阿片类药物毒性，包括致命的过量和阿片类药物依赖。
本文概述了丁丙诺啡的药理学，并回顾了高剂量舌下丁丙诺啡-纳洛酮在治疗有发生慢性阿片类药物使用并发症高风险的患者的药理学管理中的应用的现有证据。
丁丙诺啡-纳洛酮在慢性疼痛患者中耐受性良好，并有改善疼痛评分和情感症状的潜力。这在一项基于作者在成瘾医学环境中的经验的案例研究中得到了体现。由于澳大利亚开具处方药物类阿片的比率和相关危害继续增加，丁丙诺啡-纳洛酮是一种可行的选择，可用于管理无法减少或停止使用阿片类药物的高风险慢性疼痛患者。
