Ellerbroek Hannah, Kalkman Gerard A, Kramers Cornelis, Schellekens Arnt F A, van den Bemt Bart J F
Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands.
J Clin Med. 2024 Dec 19;13(24):7770. doi: 10.3390/jcm13247770.
: As long-term prescription opioid use is associated with increased morbidity and mortality, timely dose reduction of prescription opioids should be considered. However, most research has been conducted on patients using heroin. Given the differences between prescription and illicit opioid use, the aim of this review was to provide an overview of pharmacological strategies to reduce prescription opioid use or improve clinical outcomes for people who experience long-term prescription opioid use, including those with opioid use disorder. : We conducted a systematic database search of PubMed, Embase, CINAHL, and the Cochrane Library. Outcomes included dose reduction, treatment dropout, pain, addiction, and outcomes relating to quality of life (depression, functioning, quality of life). : We identified thirteen studies (eight randomized controlled trials and five observational studies). Pharmacological strategies were categorized into two categories: (1) deprescribing (tapering) opioids or (2) opioid agonist treatment (OAT) with long-acting opioids. Tapering strategies decreased opioid dosage and had mixed effects on pain and addiction. OAT with buprenorphine or methadone led to improvements in pain relief and quality of life, with a slight (non-significant) preference for methadone in terms of treatment retention (RR = 1.10 [CI: 0.89-1.37]) but not for other outcomes. Most studies had high dropout rates and a serious risk of bias. : Tapering reduced prescription opioid doses had mixed effects on pain. OAT improved clinical outcomes without dose reduction. Based on our review findings, there is no clear preference for either tapering or OAT. Tapering may be considered first as it reduces dependency, tolerance, and side effects, but is associated with adverse events and not always feasible. OAT can be a suitable alternative. Non-pharmacological interventions may facilitate tapering. Further research is needed to identify novel pharmacological strategies to facilitate opioid tapering. PROSPERO 2022 CRD42022323468.
由于长期使用处方阿片类药物与发病率和死亡率增加相关，应考虑及时减少处方阿片类药物的剂量。然而，大多数研究是针对使用海洛因的患者进行的。鉴于处方阿片类药物使用与非法阿片类药物使用之间的差异，本综述的目的是概述减少处方阿片类药物使用或改善长期使用处方阿片类药物的人群（包括患有阿片类药物使用障碍的人群）临床结局的药理学策略。：我们对PubMed、Embase、CINAHL和Cochrane图书馆进行了系统的数据库检索。结局包括剂量减少、治疗退出、疼痛、成瘾以及与生活质量相关的结局（抑郁、功能、生活质量）。：我们确定了13项研究（8项随机对照试验和5项观察性研究）。药理学策略分为两类：（1）停用（逐渐减量）阿片类药物或（2）使用长效阿片类药物进行阿片类激动剂治疗（OAT）。逐渐减量策略可降低阿片类药物剂量，对疼痛和成瘾有混合影响。使用丁丙诺啡或美沙酮进行OAT可改善疼痛缓解和生活质量，在治疗保留率方面对美沙酮有轻微（无统计学意义）偏好（RR = 1.10 [CI：0.89 - 1.37]），但在其他结局方面并非如此。大多数研究的脱落率较高且存在严重的偏倚风险。：逐渐减量减少处方阿片类药物剂量对疼痛有混合影响。OAT在不减量的情况下改善了临床结局。根据我们的综述结果，对于逐渐减量或OAT没有明确的偏好。可首先考虑逐渐减量，因为它可降低依赖性、耐受性和副作用，但与不良事件相关且并非总是可行。OAT可以是一种合适的替代方法。非药物干预可能有助于逐渐减量。需要进一步研究以确定促进阿片类药物逐渐减量的新型药理学策略。PROSPERO 2022 CRD42022323468。
