Black Anne C, Becker William C
Yale School of Medicine, New Haven, CT (ACB, WCB); Yale Program in Addiction Medicine, New Haven, CT (ACB, WCB); and VA Connecticut Healthcare System, West Haven, CT (ACB, WCB).
J Addict Med. 2025 Mar 11. doi: 10.1097/ADM.0000000000001452.
Opioid use disorder affects millions of people nationally and in 2022 opioid overdose deaths exceeded 80,000. Buprenorphine, a partial mu-opioid receptor agonist, is a gold standard treatment for opioid use disorder, improving withdrawal symptoms and decreasing opioid-related mortality. However, a 2022 Food and Drug Administration warning about oral health problems related to transmucosal formulations has precipitated new research into this medication's potential risks. Two timely studies included in this issue of Journal of Addiction Medicine provide important new insight into potential causal effects and mechanisms of transmucosal buprenorphine's impact on oral disease. Using propensity score-weighted survival analysis, Tuan and colleagues demonstrated significantly greater risk for oral health problems in patients with opioid use disorder exposed to transmucosal buprenorphine compared to those not exposed. Taking a vastly different approach, Zheng and colleagues explored mechanisms of oral health risk by exposing rats to transmucosal or intravenous buprenorphine. Results described prolonged oral fluid buprenorphine exposure, a condition proposed to increase risk for tooth decay, was associated with greater accumulated buprenorphine in the salivary gland associated with sublingual buprenorphine administration. These novel studies advance our understanding of the plausibility of a causal relationship between transmucosal buprenorphine and oral health problems and suggest the importance of prescriber-patient discussions about risk mitigating oral hygiene practices and close monitoring of oral disease development. Additional research is needed into the relative oral health risks of full-opioid agonist versus transmucosal buprenorphine exposure and current barriers to long-acting injectable buprenorphine.
阿片类药物使用障碍在全国影响着数百万人，2022年阿片类药物过量死亡人数超过8万。丁丙诺啡作为一种部分μ-阿片受体激动剂，是治疗阿片类药物使用障碍的金标准，可改善戒断症状并降低与阿片类药物相关的死亡率。然而，2022年美国食品药品监督管理局（Food and Drug Administration）发布的关于经黏膜制剂相关口腔健康问题的警告引发了对这种药物潜在风险的新研究。本期《成瘾医学杂志》（Journal of Addiction Medicine）发表的两项及时研究为经黏膜丁丙诺啡对口腔疾病的潜在因果效应和机制提供了重要的新见解。通过倾向得分加权生存分析，段（Tuan）及其同事证明，与未接触经黏膜丁丙诺啡的阿片类药物使用障碍患者相比，接触经黏膜丁丙诺啡的患者出现口腔健康问题的风险显著更高。郑（Zheng）及其同事采用了截然不同的方法，通过让大鼠接触经黏膜或静脉注射丁丙诺啡来探究口腔健康风险的机制。研究结果表明，经黏膜丁丙诺啡暴露导致口腔液体中丁丙诺啡暴露时间延长，这一情况被认为会增加龋齿风险，且与舌下给药相关的唾液腺中丁丙诺啡积累量增加有关。这些新研究增进了我们对经黏膜丁丙诺啡与口腔健康问题之间因果关系合理性的理解，并表明了医生与患者讨论降低风险的口腔卫生习惯以及密切监测口腔疾病发展的重要性。还需要进一步研究全阿片类激动剂与经黏膜丁丙诺啡暴露的相对口腔健康风险，以及长效注射用丁丙诺啡目前存在的障碍。
