Department of Psychiatry, National Drug Dependence Treatment Centre, All India Insti-tute of Medical Sciences, New Delhi, India.
Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India. ORCID: https://orcid.org/0000-0002-3827-1549.
J Opioid Manag. 2021;17(7):141-152. doi: 10.5055/jom.2021.0651.
Opioid use disorder is a major public health problem, and opioid replacement therapy with buprenorphine (BPN) is a clinically effective and evidence-based treatment for it. To deter misuse of the tablet through the injecting route, BPN coformulated with naloxone (BNX) in 4:1 ratio is available in many countries. Despite this, significant diversion and injecting use of the BNX combination has been reported from across the world. In this article, the pharmacological properties of BPN and BNX and the evidence for their diversion are reviewed. Also, a critical examination is made of the evidence supporting the role of naloxone in reducing the agonist effects of BPN when used through the injecting route. Based on this evidence, a hypothesis explaining the continued diversion of BNX has been proposed.
阿片类使用障碍是一个主要的公共卫生问题，丁丙诺啡（BPN）替代疗法是一种临床有效且有证据支持的治疗方法。为了防止通过注射途径滥用片剂，许多国家都提供了丁丙诺啡与纳洛酮（BNX）以 4:1 比例配制的组合药物。尽管如此，仍有来自世界各地的报告称，这种 BNX 组合药物大量被转移和用于注射。本文综述了 BPN 和 BNX 的药理学特性及其被转移的证据。此外，还对支持纳洛酮在通过注射途径使用时降低 BPN 激动剂作用的证据进行了批判性评估。基于这些证据，提出了一个假设来解释 BNX 持续被转移的原因。
