Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.
Department of Psychiatry, Washington University in St. Louis Euclid Ave, St. Louis, MO, United States.
Front Public Health. 2024 Jan 25;11:1274719. doi: 10.3389/fpubh.2023.1274719. eCollection 2023.
Opioid use disorder (OUD) is a major public health threat, contributing to morbidity and mortality from addiction, overdose, and related medical conditions. Despite our increasing knowledge about the pathophysiology and existing medical treatments of OUD, it has remained a relapsing and remitting disorder for decades, with rising deaths from overdoses, rather than declining. The COVID-19 pandemic has accelerated the increase in overall substance use and interrupted access to treatment. If increased naloxone access, more buprenorphine prescribers, greater access to treatment, enhanced reimbursement, less stigma and various harm reduction strategies were effective for OUD, overdose deaths would not be at an all-time high. Different prevention and treatment approaches are needed to reverse the concerning trend in OUD. This article will review the recent trends and limitations on existing medications for OUD and briefly review novel approaches to treatment that have the potential to be more durable and effective than existing medications. The focus will be on promising interventional treatments, psychedelics, neuroimmune, neutraceutical, and electromagnetic therapies. At different phases of investigation and FDA approval, these novel approaches have the potential to not just reduce overdoses and deaths, but attenuate OUD, as well as address existing comorbid disorders.
阿片类使用障碍(OUD)是一个主要的公共卫生威胁,导致成瘾、过量用药和相关医疗状况的发病率和死亡率上升。尽管我们对 OUD 的病理生理学和现有医疗治疗方法的了解不断增加,但几十年来,它仍然是一种反复发作和缓解的疾病,过量用药导致的死亡人数呈上升趋势,而不是下降。COVID-19 大流行加速了整体物质使用的增加,并中断了治疗的获取。如果增加纳洛酮的获取、更多的丁丙诺啡开处方者、更多的治疗机会、增强报销、减少污名化以及各种减少伤害的策略对 OUD 有效,那么过量用药死亡人数就不会达到历史最高水平。需要采取不同的预防和治疗方法来扭转 OUD 令人担忧的趋势。本文将回顾 OUD 现有药物的最新趋势和局限性,并简要回顾有潜力比现有药物更持久和有效的新型治疗方法。重点将放在有前途的干预性治疗、迷幻药、神经免疫、营养神经和电磁疗法上。在不同的研究阶段和 FDA 批准阶段,这些新方法有可能不仅减少过量用药和死亡,还能减轻 OUD,并解决现有的合并症。