Olympia Bupe Clinic at Capital Recovery Center, Olympia, WA; University of Washington Department of Family Medicine, Seattle, WA; Pioneer Family Practice, Lacey, WA.
J Addict Med. 2022;16(1):4-6. doi: 10.1097/ADM.0000000000000837.
Buprenorphine-naloxone (BNX) reduces the risk of mortality from untreated opioid use disorder by 50% or more. However, adverse effects of BNX can be a cause of inconsistent use or discontinuation. The buprenorphine monoproduct (BUP) is effective and is sometimes tolerated better, but practice guidelines and insurance restrictions discourage its prescription due to concerns about diversion and injection. An idiopathic reaction of bilateral flank pain reported by three patients is used as an example to show how to assess the success of a BUP trial. Sublingual absorption of naloxone is discussed as a potential cause of adverse effects of BNX in sensitive individuals. Issues in clinical decision-making are presented to help prescribers assess the risk-benefit ratio of a BUP trial for the individual patient, the prescriber, and society. This commentary may serve as a stimulus for changes in practice guidelines and insurance coverage policies to allow greater flexibility in the prescribing of BUP.
丁丙诺啡-纳洛酮（BNX）可将未经治疗的阿片类使用障碍导致的死亡率降低 50%或更多。然而，BNX 的不良反应可能导致用药不规律或停药。丁丙诺啡单产品（BUP）是有效的，有时耐受性更好，但由于对转移和注射的担忧，实践指南和保险限制阻碍了其处方。本文以三名患者报告的双侧肋部疼痛的特发性反应为例，说明如何评估 BUP 试验的成功。讨论了纳洛酮的舌下吸收，因为它可能是敏感个体 BNX 不良反应的一个潜在原因。本文提出了临床决策中的问题，以帮助医生评估个体患者、医生和社会进行 BUP 试验的风险效益比。本评论可能会促使实践指南和保险覆盖政策发生变化，从而允许在 BUP 的处方方面更加灵活。
