From the Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven CT (OJ, JPDA, CH, EC, IP, SBM); and Cushing/John Hay Whitney Medical Library, Yale University School of Medicine (MCF).
J Addict Med. 2024;18(5):499-510. doi: 10.1097/ADM.0000000000001356. Epub 2024 Aug 10.
The clinical implications of high potency synthetic opioids (HPSO) on medications for opioid use disorder (MOUDs) are not well understood. Although pharmacological interactions are plausible, the clinical significance of such interaction has not been systematically elucidated. This scoping review investigates the relationship between HPSO exposure and various MOUD treatment outcomes.
We followed PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews) for scoping reviews with extensive a priori search strategy of databases: MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL, and Cochrane.
From 9149 studies, 34 fulfilled the inclusion criteria. Synthesized data reveal several critical insights: First, there is a variable but high occurrence (38%-80%) of HPSO usage among individuals with MOUDs. Second, MOUDs are linked to a decreased risk of overdoses and deaths associated with HPSO. Third, HPSO consumption is correlated with the risk of precipitated withdrawal when starting buprenorphine. Fourth, low-dose buprenorphine is being recognized as one method to avoid moderate withdrawal symptoms prior to treatment. Lastly, significant gaps exist in human experimental data concerning the effects of HPSO on key factors critical for treating OUD-craving, withdrawal symptoms, and pain.
Current evidence supports MOUD safety and effectiveness in reducing nonmedical opioid use. Further research is needed to explore HPSO's influence on the acute factors preceding nonmedical opioid use, such as cravings, withdrawal symptoms, and pain. This research could inform the optimization of MOUD dosing strategies. Achieving consensus and harmonizing data across clinical and research protocols could diminish variability, enhancing our understanding of HPSOs effect on MOUD treatment outcomes.
高强度合成阿片类药物（HPSO）对阿片类药物使用障碍（MOUD）药物的临床影响尚不清楚。尽管药物相互作用是合理的，但这种相互作用的临床意义尚未系统阐明。本范围综述调查了 HPSO 暴露与各种 MOUD 治疗结果之间的关系。
我们遵循 PRISMA-ScR（系统评价和荟萃分析扩展的首选报告项目用于范围综述），采用广泛的预先确定的数据库搜索策略：MEDLINE、EMBASE、PsycINFO、Web of Science、CINAHL 和 Cochrane。
从 9149 项研究中，有 34 项符合纳入标准。综合数据揭示了一些关键见解：首先，在接受 MOUD 的人群中，HPSO 的使用频率存在差异，但很高（38%-80%）。其次，MOUD 与与 HPSO 相关的过量和死亡风险降低有关。第三，当开始使用丁丙诺啡时，HPSO 的消耗与诱发戒断的风险相关。第四，低剂量丁丙诺啡被认为是避免治疗前中度戒断症状的一种方法。最后，关于 HPSO 对治疗 OUD 渴望、戒断症状和疼痛的关键因素的影响，人类实验数据存在重大差距。
目前的证据支持 MOUD 的安全性和有效性，可降低非医疗性阿片类药物的使用。需要进一步研究以探讨 HPSO 对非医疗性阿片类药物使用前的急性因素的影响，例如渴望、戒断症状和疼痛。这项研究可以为优化 MOUD 剂量策略提供信息。通过达成共识并协调临床和研究方案中的数据，可以减少变异性，增强我们对 HPSO 对 MOUD 治疗结果的影响的理解。
