Kim Eun-Ji, Hwang Eun-Jung, Yoo Yeong-Min, Kim Kyung-Hoon
Department of Pharmacy, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea.
Korean J Pain. 2022 Oct 1;35(4):361-382. doi: 10.3344/kjp.2022.35.4.361.
The third opium war may have already started, not only due to illicit opioid trafficking from the Golden Crescent and Golden Triangle on the international front but also through indiscriminate opioid prescription and opioid diversion at home. Opioid use disorder (OUD), among unintentional injuries, has become one of the top 4 causes of death in the United States (U.S.). An OUD is defined as a problematic pattern of opioid use resulting in clinically significant impairment or distress, consisting of 2 or more of 11 problems within 1 year, as described by the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Observation of aberrant behaviors of OUD is also helpful for overworked clinicians. For the prevention of OUD, the Opioid Risk Tool and the Current Opioid Misuse Measure are appropriate screening tests before and during opioid administration, respectively. Treatment of OUD consists of 3 opioid-based U.S. Food and Drug Administration-approved medications, including methadone, buprenorphine, and naltrexone, and non-opioid-based symptomatic medications for reducing opioid withdrawal syndromes, such as α2 agonists, β-blockers, antidiarrheals, antiemetics, non-steroidal anti-inflammatory drugs, and benzodiazepines. There are at least 6 recommendable guidelines and essential terms related to OUD. Opioid stewardship programs are now critical to promoting appropriate use of opioid medications, improving patient outcomes, and reducing misuse of opioids, influenced by the successful implementation of antimicrobial stewardship programs. Despite the lack of previous motivation, now is the critical time for trying to reduce the risk of OUD.
第三次鸦片战争可能已经打响，这不仅源于国际上来自金新月和金三角地区的非法阿片类药物贩运，还源于国内阿片类药物的滥开处方和药物滥用。在美国，阿片类药物使用障碍（OUD）已成为意外伤害中导致死亡的四大主要原因之一。根据《精神疾病诊断与统计手册（第五版）》的描述，OUD被定义为一种有问题的阿片类药物使用模式，导致临床上明显的损害或痛苦，在1年内出现11种问题中的2种或更多。观察OUD的异常行为对劳累过度的临床医生也有帮助。为预防OUD，阿片类药物风险工具和当前阿片类药物滥用措施分别是阿片类药物给药前和给药期间合适的筛查测试。OUD的治疗包括3种美国食品药品监督管理局批准的基于阿片类药物的药物，即美沙酮、丁丙诺啡和纳曲酮，以及用于减轻阿片类药物戒断综合征的非阿片类对症药物，如α2激动剂、β受体阻滞剂、止泻药、止吐药、非甾体抗炎药和苯二氮䓬类药物。至少有6项与OUD相关的推荐指南和基本术语。受抗菌药物管理计划成功实施的影响，阿片类药物管理计划对于促进阿片类药物的合理使用、改善患者预后以及减少阿片类药物滥用至关重要。尽管此前缺乏动力，但现在是降低OUD风险的关键时机。
