Veronin Michael A, Reinert Justin P
Department of Pharmaceutical Sciences and Health Outcomes The University of Texas at Tyler Ben and Maytee Fisch College of Pharmacy, Tyler, TX, USA.
Department of Pharmacy Practice The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA.
Subst Abuse Rehabil. 2024 Oct 19;15:197-207. doi: 10.2147/SAR.S468259. eCollection 2024.
The misuse of and dependency on prescription opioids represents a significant crisis at the national level, impacting not only the health of the public but also the societal and economic well-being. There is a critical need for strategies to reduce the dosage of prescribed opioids to limit opioid-associated adverse effects and lower the risk of addiction development in patients experiencing chronic pain. Opioid-sparing medications, when co-administered with opioids, enable a reduced opioid dose without loss of efficacy. This suggests the potential for using opioid adjunct drugs in opioid tapering, whereby opioid doses are lowered incrementally in a systematic manner to improve a patient's safety profile or quality of life. The objective of this report is two-fold: 1) to illustrate the potential for adjunct drugs in opioid tapering, and 2) to describe the steps needed to be taken to develop a framework for the use of adjunct drugs in opioid tapering. This can provide the impetus for further investigation into opioid tapering and the development of improved clinical care. The proposed project implements knowledge synthesis methods to develop the framework for a new paradigm of opioid drug tapering that incorporates opioid dosage reductions with adjunct drugs. Framework development is organized into three major phases: 1) Adjunct drug characterization, 2) Assessment of the opioid-sparing effect, and 3) Usability of data for clinicians. The knowledge gained from this project can provide a foundation for improved analgesia protocols for opioids and adjunctive drug therapy.
处方阿片类药物的滥用和依赖在国家层面构成了重大危机，不仅影响公众健康，还影响社会和经济福祉。迫切需要采取策略来减少处方阿片类药物的剂量，以限制阿片类药物相关的不良反应，并降低慢性疼痛患者成瘾的风险。当与阿片类药物联合使用时，阿片类药物节省型药物能够在不损失疗效的情况下降低阿片类药物剂量。这表明在阿片类药物减量过程中使用阿片类辅助药物具有潜力，即通过系统地逐步降低阿片类药物剂量来改善患者的安全状况或生活质量。本报告的目的有两个：1）说明辅助药物在阿片类药物减量中的潜力，2）描述制定阿片类药物减量中辅助药物使用框架所需采取的步骤。这可为进一步研究阿片类药物减量和改善临床护理提供动力。拟议的项目采用知识综合方法来制定一种新的阿片类药物减量范式的框架，该范式将阿片类药物剂量减少与辅助药物相结合。框架开发分为三个主要阶段：1）辅助药物特征描述，2）阿片类药物节省效果评估，3）临床医生数据的可用性。从该项目中获得的知识可为改进阿片类药物镇痛方案和辅助药物治疗提供基础。
