Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
J Addict Dis. 2024 Jul-Sep;42(3):253-263. doi: 10.1080/10550887.2023.2195777. Epub 2023 May 18.
The opioid epidemic and limited access to treatment for opioid withdrawal (OW) and opioid use disorder (OUD) has led individuals to seek alternative treatments. This narrative review aims to educate clinicians on the mechanisms of action, toxicity, and applications of psychoactive plant-based substances patients may be using to self-treat OUD and OW. We specifically discuss ayahuasca, ibogaine, and kratom as they have the most evidence for applications in OUD and OW from the last decade (2012-2022). Evidence suggests these substances may have efficacy in treating OW and OUD through several therapeutic mechanisms including their unique pharmacodynamic effects, rituals performed around ingestion, and increased neuroplasticity. The current evidence for their therapeutic application in OUD and OW is primarily based on small observational studies or animal studies. High-quality, longitudinal studies are needed to clarify safety and efficacy of these substances in treatment of OW and OUD.
阿片类药物泛滥以及阿片类戒断（OW）和阿片类使用障碍（OUD）治疗机会有限，导致人们寻求替代治疗方法。本叙事性综述旨在向临床医生介绍可能用于自我治疗 OUD 和 OW 的精神活性植物物质的作用机制、毒性和应用。我们特别讨论了 ayahuasca、ibogaine 和 kratom，因为它们在过去十年（2012-2022 年）中在 OUD 和 OW 应用方面的证据最多。有证据表明，这些物质可能通过多种治疗机制对 OW 和 OUD 具有疗效，包括其独特的药效学作用、摄入时进行的仪式以及增加的神经可塑性。目前关于这些物质在 OUD 和 OW 中的治疗应用的证据主要基于小型观察性研究或动物研究。需要进行高质量、纵向研究来阐明这些物质在治疗 OW 和 OUD 中的安全性和疗效。
