Zeine Foojan, Jafari Nicole, Baron David, Bowirrat Abdalla, Pinhasov Albert, Norling Brian, Martinez Kathleen Carter, Nami Mohammad, Manavi Nima, Sunder Keerthy, Rabin David M, Bagchi Debasis, Khalsa Jag, Gold Mark S, Sipple Daniel, Barzegar Mojtaba, Bodhanapati Jothsna, Khader Waseem, Carney Paul, Dennen Catherine A, Gupta Ashim, Elman Igor, Badgaiyan Rajendra D, Modestino Edward J, Thanos Panayotis K, Hanna Colin, McLaughlin Thomas, Cadet Jean Lud, Soni Diwanshu, Braverman Eric R, Barh Debmalya, Giordano John, Edwards Drew, Ashford J Wesson, Gondre-Lewis Marjorie C, Gilley Elizebeth, Murphy Kevin T, Lewandrowski Kai-Uwe, Sharafshah Alireza, Makale Milan, Fuehrlein Brian, Blum Kenneth
Awareness Integration Institute, San Clemente, USA.
Department of Health Science, California State University, Long Beach, USA.
J Addict Psychiatry. 2024;8(1):50-95. Epub 2024 Jun 20.
The opioid crisis in the last few decades has mounted to a global level, impacting all areas of socioeconomic, demographic, geographic, and cultural boundaries. Traditional treatments have not been deemed to show the degree of efficacy necessary to address the crisis. The authors of this review paper have set forth an unprecedented and in-depth look into multi-factorial determinants that have contributed to the opioid crisis becoming global and multi-faceted.
For this narrative review/opinion article, we searched PsychINFO, PubMed, Google Scholar, and Web of Science databases to identify relevant articles on topics including the "opioid crisis," "opioid mechanisms," "genetics and epigenetics," "neuropharmacology," and "clinical aspects of opioid treatment and prevention." Since this was not a systematic review the articles selected could represent unitential bias.
Despite some success achieved through Opioid Substitution Therapy (OST) in harm reduction, the annual mortality toll in the US alone surpasses 106,699 individuals, a figure expected to climb to 165,000 by 2025. Data from the Substance Abuse and Mental Health Services Administration's (SAMHSA) National Survey on Drug Abuse and Health (NSDUH) reveals that approximately 21.4% of individuals in the US engaged in illicit drug use in 2020, with 40.3 million individuals aged 12 or older experiencing a Substance Use Disorder (SUD). Provisional figures from the Centers for Disease Control and Prevention (CDC) indicate a troubling 15% increase in overdose deaths in 2021, rising from 93,655 in 2020 to 107,622, with opioids accounting for roughly 80,816 of these deaths.
We advocate reevaluating the "standard of care" and shifting towards inducing dopamine homeostasis by manipulating key neurotransmitter systems within the brain's reward cascade. We propose a paradigm shift towards a novel "standard of care" that begins with incorporating Genetic Addiction Risk Severity (GARS) testing to assess pre-addiction risk and vulnerability to opioid-induced addiction; emphasis should be placed on inducing dopamine homeostasis through safe and non-addictive alternatives like KB220, and comprehensive treatment approaches that address psychological, spiritual, and societal aspects of addiction through Awareness Integration Therapy (AIT).
在过去几十年里，阿片类药物危机已上升到全球层面，影响着社会经济、人口、地理和文化边界的各个领域。传统治疗方法被认为未显示出应对该危机所需的疗效程度。这篇综述论文的作者对导致阿片类药物危机变得全球化和多面化的多因素决定因素进行了前所未有的深入研究。
对于这篇叙述性综述/观点文章，我们检索了PsychINFO、PubMed、谷歌学术和科学网数据库，以识别有关“阿片类药物危机”、“阿片类药物机制”、“遗传学和表观遗传学”、“神经药理学”以及“阿片类药物治疗与预防的临床方面”等主题的相关文章。由于这不是一项系统综述，所选文章可能存在无意的偏差。
尽管阿片类药物替代疗法（OST）在减少危害方面取得了一些成功，但仅在美国，每年的死亡人数就超过106,699人，预计到2025年这一数字将攀升至165,000人。物质滥用和精神健康服务管理局（SAMHSA）的全国药物滥用和健康调查（NSDUH）数据显示，2020年美国约21.4%的人使用非法药物，4030万12岁及以上的人患有物质使用障碍（SUD）。疾病控制与预防中心（CDC）的初步数据表明，2021年过量用药死亡人数令人不安地增加了15%，从2020年的93,655人增至107,622人，其中阿片类药物导致的死亡约为80,816人。
我们主张重新评估“护理标准”，并通过操纵大脑奖赏级联中的关键神经递质系统来诱导多巴胺稳态。我们提议向一种新的“护理标准”范式转变，首先纳入遗传成瘾风险严重程度（GARS）测试，以评估成瘾前风险和对阿片类药物诱导成瘾的易感性；应强调通过安全且无成瘾性的替代品（如KB220）诱导多巴胺稳态，以及通过意识整合疗法（AIT）解决成瘾的心理、精神和社会方面问题的综合治疗方法。
