阿片类药物戒断治疗的新方向。
New directions in the treatment of opioid withdrawal.
机构信息
Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA.
Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA.
出版信息
Lancet. 2020 Jun 20;395(10241):1938-1948. doi: 10.1016/S0140-6736(20)30852-7.
Abstract
The treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with μ-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and α2-adrenergic receptor agonists (eg, clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.
摘要
治疗阿片类药物戒断是治疗慢性非癌性疼痛患者、阿片类药物使用障碍活跃患者和接受阿片类药物使用障碍药物治疗患者时临床关注的重要领域。目前，医学监督戒断的标准治疗包括使用 μ-阿片受体激动剂（如美沙酮）、部分激动剂（如丁丙诺啡）和 α2-肾上腺素能受体激动剂（如可乐定和可乐定）。新型药物同样利用这些药理机制，包括曲马多（μ-阿片受体激动剂）和替扎尼定（α2 激动剂）。未来的研究领域包括在稳定阿片类药物使用障碍患者至纳曲酮长效制剂的背景下管理戒断，将阿片类药物使用障碍患者从美沙酮转为丁丙诺啡，以及在慢性非癌性疼痛患者中逐渐减少阿片类药物用量。
相似文献
1
New directions in the treatment of opioid withdrawal.阿片类药物戒断治疗的新方向。
Lancet. 2020 Jun 20;395(10241):1938-1948. doi: 10.1016/S0140-6736(20)30852-7.
2
Buprenorphine for managing opioid withdrawal.丁丙诺啡用于管理阿片类药物戒断。
Cochrane Database Syst Rev. 2017 Feb 21;2(2):CD002025. doi: 10.1002/14651858.CD002025.pub5.
3
Management of opioid withdrawal symptoms.阿片类药物戒断症状的管理。
Med Lett Drugs Ther. 2018 Aug 27;60(1554):137-141.
4
Expanded table: Some drugs for management of opioid withdrawal symptoms.扩展表格：用于管理阿片类药物戒断症状的一些药物。
Med Lett Drugs Ther. 2018 Aug 27;60(1554):e144-e146.
5
Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial.曲马多缓释片用于阿片类药物戒断的疗效：一项随机临床试验。
JAMA Psychiatry. 2017 Sep 1;74(9):885-893. doi: 10.1001/jamapsychiatry.2017.1838.
6
A novel non-opioid protocol for medically supervised opioid withdrawal and transition to antagonist treatment.一种用于医学监督下阿片类药物戒断及向拮抗剂治疗过渡的新型非阿片类方案。
Am J Drug Alcohol Abuse. 2018;44(3):302-309. doi: 10.1080/00952990.2017.1334209. Epub 2017 Aug 10.
7
The combination very low-dose naltrexone-clonidine in the management of opioid withdrawal.纳曲酮-可乐定联合小剂量治疗阿片类药物戒断。
Am J Drug Alcohol Abuse. 2012 May;38(3):200-5. doi: 10.3109/00952990.2011.644003. Epub 2012 Jan 10.
8
Update on pharmacotherapy for treatment of opioid use disorder.阿片类物质使用障碍治疗的药物治疗进展
Expert Opin Pharmacother. 2016 Dec;17(17):2307-2318. doi: 10.1080/14656566.2016.1244529. Epub 2016 Oct 20.
9
Opioid detoxification and naltrexone induction strategies: recommendations for clinical practice.阿片类药物脱毒和纳曲酮诱导策略：临床实践建议。
Am J Drug Alcohol Abuse. 2012 May;38(3):187-99. doi: 10.3109/00952990.2011.653426. Epub 2012 Mar 12.
10
Adjunctive memantine for opioid use disorder treatment: A systematic review.辅助美金刚治疗阿片类药物使用障碍：系统评价。
J Subst Abuse Treat. 2019 Dec;107:38-43. doi: 10.1016/j.jsat.2019.10.003. Epub 2019 Oct 20.
引用本文的文献
1
Dry eye disease and psychosomatics-benefits of mind-body therapy for dry eye disease.干眼症与身心医学——身心疗法对干眼症的益处
Front Med (Lausanne). 2025 Aug 20;12:1600258. doi: 10.3389/fmed.2025.1600258. eCollection 2025.
2
Biochemical Identification and Clinical Description of Medetomidine Exposure in People Who Use Fentanyl in Philadelphia, PA.宾夕法尼亚州费城使用芬太尼人群中咪达托咪定暴露的生化鉴定与临床描述
Int J Mol Sci. 2025 Jul 13;26(14):6715. doi: 10.3390/ijms26146715.
3
High induction rate onto extended-release naltrexone for people with opioid use disorder: experiences from a Norwegian naturalistic study.长效纳曲酮对阿片类物质使用障碍患者的高诱导率：一项挪威自然主义研究的经验
Addict Sci Clin Pract. 2025 Jun 16;20(1):50. doi: 10.1186/s13722-025-00576-9.
4
Outpatient-based buprenorphine-assisted opioid withdrawal management: A preliminary prospective observational study.基于门诊的丁丙诺啡辅助阿片类药物戒断管理：一项初步前瞻性观察性研究。
Indian J Psychiatry. 2025 Apr;67(4):428-431. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_1084_24. Epub 2025 Apr 15.
5
Noninvasive Brain Stimulation for Opioid Use Disorder: An Update of the Literature.用于阿片类物质使用障碍的无创脑刺激：文献综述
Curr Behav Neurosci Rep. 2025;12(1). doi: 10.1007/s40473-024-00293-8. Epub 2025 Feb 3.
6
Sustained Release of αO-Conotoxin GeXIVA[1,2] via Hydrogel Microneedle Patch for Chronic Neuropathic Pain Management.通过水凝胶微针贴片持续释放αO-芋螺毒素GeXIVA[1,2]用于慢性神经性疼痛管理。
Mar Drugs. 2025 Apr 7;23(4):161. doi: 10.3390/md23040161.
7
Inhibition of autophagy in the amygdala ameliorates anxiety-like behaviors induced by morphine-protracted withdrawal in male mice.杏仁核中自噬的抑制可改善雄性小鼠吗啡长期戒断诱导的焦虑样行为。
Neuroreport. 2025 Jun 4;36(9):487-496. doi: 10.1097/WNR.0000000000002166. Epub 2025 Apr 23.
8
Comprehensive mini-review: therapeutic potential of cannabigerol - focus on the cardiovascular system.综述：大麻二酚的治疗潜力——聚焦于心血管系统
Front Pharmacol. 2025 Mar 26;16:1561385. doi: 10.3389/fphar.2025.1561385. eCollection 2025.
9
The role of 5-HT modulation in opioid withdrawal and neonatal opioid withdrawal syndrome: mechanisms and potential serotonergic targets.5-羟色胺调节在阿片类药物戒断及新生儿阿片类药物戒断综合征中的作用：机制及潜在的5-羟色胺能靶点
Expert Opin Investig Drugs. 2025 Jan-Feb;34(1-2):49-59. doi: 10.1080/13543784.2025.2462615. Epub 2025 Feb 8.
10
Associations Among Sleep, Pain, and Medications for Opioid Use Disorder: a Scoping Review.睡眠、疼痛与阿片类物质使用障碍药物之间的关联：一项范围综述
Curr Addict Rep. 2024 Dec;11(6):965-981. doi: 10.1007/s40429-024-00606-7. Epub 2024 Oct 25.
本文引用的文献
1
Medication-Assisted Treatment for Opioid-Use Disorder.阿片类物质使用障碍的药物辅助治疗。
Mayo Clin Proc. 2019 Oct;94(10):2072-2086. doi: 10.1016/j.mayocp.2019.03.029. Epub 2019 Sep 19.
2
Patient Barriers and Facilitators to Medications for Opioid Use Disorder in Primary Care.患者在初级保健中使用治疗阿片类药物使用障碍药物的障碍和促进因素。
Subst Use Misuse. 2019;54(14):2409-2419. doi: 10.1080/10826084.2019.1653324. Epub 2019 Aug 20.
3
Transitioning Hospitalized Patients with Opioid Use Disorder from Methadone to Buprenorphine without a Period of Opioid Abstinence Using a Microdosing Protocol.使用微量剂量方案，在不进行阿片类药物戒断期的情况下，将患有阿片类药物使用障碍的住院患者从美沙酮转为丁丙诺啡。
Pharmacotherapy. 2019 Oct;39(10):1023-1029. doi: 10.1002/phar.2313. Epub 2019 Aug 15.
4
Management of opioid use disorder in the USA: present status and future directions.美国阿片类药物使用障碍的管理：现状与未来方向。
Lancet. 2019 Apr 27;393(10182):1760-1772. doi: 10.1016/S0140-6736(18)33078-2. Epub 2019 Mar 14.
5
Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.每月一次丁丙诺啡储库注射治疗阿片类药物使用障碍的疗效和安全性：一项多中心、随机、双盲、安慰剂对照、3 期临床试验。
Lancet. 2019 Feb 23;393(10173):778-790. doi: 10.1016/S0140-6736(18)32259-1. Epub 2019 Feb 18.
6
Kratom (Mitragynine) Ingestion Requiring Naloxone Reversal.服用可待因（吗啡碱）后需用纳洛酮进行逆转。
Clin Pract Cases Emerg Med. 2019 Jan 4;3(1):24-26. doi: 10.5811/cpcem.2018.11.40588. eCollection 2019 Feb.
7
Lofexidine: A Newly FDA-Approved, Nonopioid Treatment for Opioid Withdrawal.可乐定：一种新的美国 FDA 批准的阿片类药物戒断的非类药物治疗方法。
Ann Pharmacother. 2019 Jul;53(7):746-753. doi: 10.1177/1060028019828954. Epub 2019 Feb 6.
8
Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment.综述文章：阿片类药物戒断症状的有效管理：阿片类药物依赖治疗的门户。
Am J Addict. 2019 Feb;28(2):55-62. doi: 10.1111/ajad.12862. Epub 2019 Jan 31.
9
Kratom Withdrawal: A Systematic Review with Case Series.**标题**：**（文章名称）**：一项系统综述及病例系列研究
**摘要**：背景：**（研究背景）**。目的：评估**（研究目的）**。方法：我们检索了 MEDLINE、EMBASE、Cochrane 图书馆、PsycINFO、Web of Science 和 Cumulative Index to Nursing and Allied Health Literature 等数据库，以确定截至 2023 年 2 月 10 日关于**（关键词）**戒断的病例报告或系列研究。结果：纳入了 15 项研究，共报告了 134 例患者。大多数参与者为男性（64.2%），平均年龄为 34.4 岁。最常见的**（关键词）**形式是**（关键词）**（71.6%），其次是**（关键词）**（15.7%）。最常见的戒断症状是焦虑（54.5%）、失眠（32.8%）、抑郁（26.9%）、疲劳（24.6%）、疼痛（21.9%）和渴求（18.7%）。在 113 例患者中，81.3%接受了药物治疗，最常用的药物是**（关键词）**（52.2%）和**（关键词）**（16.4%）。11 例患者（8.2%）出现严重不良事件，包括自杀意念和精神病。结论：目前的证据表明，**（关键词）**戒断症状通常是自限性的，但可能会对某些患者造成严重的不适。需要进一步的研究来确定最佳的治疗策略。
J Psychoactive Drugs. 2019 Jan-Mar;51(1):12-18. doi: 10.1080/02791072.2018.1562133. Epub 2019 Jan 5.
10
Safety and Efficacy of Lofexidine for Medically Managed Opioid Withdrawal: A Randomized Controlled Clinical Trial.盐酸可乐定治疗阿片类药物戒断的安全性和疗效：一项随机对照临床试验。
J Addict Med. 2019 May/Jun;13(3):169-176. doi: 10.1097/ADM.0000000000000474.
Zotero 插件