Maremmani Icro, Dematteis Maurice, Gorzelanczyk Edward J, Mugelli Alessandro, Walcher Stephan, Torrens Marta
VP Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy.
UniCamillus, International Medical University in Rome, Via di Sant'Alessandro 8, 00131 Rome, Italy.
J Clin Med. 2023 Aug 26;12(17):5575. doi: 10.3390/jcm12175575.
Long-acting buprenorphine formulations have been recently marketed for the Opioid Agonist Treatment (OAT) of opioid use disorder (OUD) associated with medical, social, and psychological support. Their duration of action ranges from one week up to 6 months. The non-medical use of opioids is increasing with a parallel rise in lethal overdoses. Methadone and buprenorphine are the standard treatment for opioid dependence. Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing the risks of overdose, crime, and transmission of HIV (Human Immunodeficiency Virus) in people who use opioids; however, its effectiveness has been hindered by low rates of uptake and retention in treatment. Furthermore, both methadone and buprenorphine are widely diverted and misused. Thus, a crucial aspect of treating OUD is facilitating patients' access to treatment while minimizing substance-related harm and improving quality of life. The newly developed long-acting buprenorphine formulations represent a significant change in the paradigm of OUD treatment, allowing an approach individualized to patients' needs. Strengths of this individualized approach are improved adherence (lack of peaks and troughs in blood concentrations) and a reduced stigma since the patient doesn't need to attend their clinic daily or nearly daily, thus facilitating social and occupational integrations as the quality of life. However, less frequent attendance at the clinic should not affect the patient-physician relationship. Therefore, teleconsulting or digital therapeutic services should be developed in parallel. In addition, diversion and intravenous misuse of buprenorphine are unlikely due to the characteristics of these formulations. These features make this approach of interest for treating OUD in particular settings, such as subjects staying or when released from prison or those receiving long-term residential treatment for OUD in the therapeutic communities. The long-lasting formulations of buprenorphine can positively impact the OUD treatment and suggest future medical and logistic developments to maximize their personalized management and impact.
长效丁丙诺啡制剂最近已上市，用于与医疗、社会和心理支持相关的阿片类物质使用障碍（OUD）的阿片类激动剂治疗（OAT）。其作用持续时间从一周到6个月不等。阿片类物质的非医疗使用正在增加，同时致命过量用药也在并行上升。美沙酮和丁丙诺啡是阿片类物质依赖的标准治疗方法。美沙酮维持治疗（MMT）被广泛认为是降低阿片类物质使用者过量用药、犯罪和艾滋病毒（人类免疫缺陷病毒）传播风险的最有效方法之一；然而，其有效性受到治疗接受率和保留率低的阻碍。此外，美沙酮和丁丙诺啡都被广泛转移和滥用。因此，治疗OUD的一个关键方面是在尽量减少与物质相关的危害并提高生活质量的同时，促进患者获得治疗。新开发的长效丁丙诺啡制剂代表了OUD治疗模式的重大变化，允许采用根据患者需求量身定制的方法。这种个性化方法的优点是依从性提高（血药浓度无峰谷波动），且耻辱感降低，因为患者无需每天或几乎每天前往诊所，从而促进社会和职业融入，提高生活质量。然而，就诊频率降低不应影响患者与医生的关系。因此，应同时开发远程咨询或数字治疗服务。此外，由于这些制剂的特性，丁丙诺啡的转移和静脉内滥用不太可能发生。这些特点使得这种方法在特定环境中治疗OUD很有意义，例如在押或出狱人员，或在治疗社区接受OUD长期住院治疗的人员。丁丙诺啡的长效制剂可对OUD治疗产生积极影响，并为未来的医疗和后勤发展提供建议，以最大限度地实现其个性化管理和影响。
