University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA.
J Behav Health Serv Res. 2020 Oct;47(4):601-613. doi: 10.1007/s11414-020-09712-6.
The U.S. is in the midst of an opioid epidemic. At the same time, tobacco use remains the leading cause of preventable death and disability. While the shared biological underpinnings of nicotine and opioid addiction are well established, clinical implications for co-treatment of these two substance use disorders has not been emphasized in the literature, nor have researchers, clinicians, and policy makers adequately outlined pathways for incorporating co-treatment into existing clinical workflows. The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics. Screening, assessment, medication-assisted treatment (MAT), and tobacco-free policy are discussed. The evidence suggests that clinical care and policies that facilitate co-treatment are an expedient means of delivering healthcare to individuals that result in better health for the population while also meeting patients' substance abuse disorder recovery goals.
美国正处于阿片类药物泛滥的困境之中。与此同时，吸烟仍然是可预防的死亡和残疾的主要原因。虽然尼古丁和阿片类药物成瘾的共同生物学基础已得到充分证实，但文献中并未强调同时治疗这两种物质使用障碍的临床意义，研究人员、临床医生和政策制定者也没有充分概述将共同治疗纳入现有临床工作流程的途径。本综述简要描述了介导尼古丁和阿片类药物共同使用的代谢和神经机制，然后概述了同时解决这两种致命性流行疾病的临床和政策意义。讨论了筛查、评估、药物辅助治疗 (MAT) 和无烟政策。有证据表明，促进共同治疗的临床护理和政策是向个人提供医疗保健的一种便捷方式，这将改善人群的健康状况，同时也满足患者的物质滥用障碍康复目标。
