阿片类药物替代疗法:安全性和滥用倾向的比较研究

阿片类药物维持疗法是治疗阿片、海洛因和阿片类制剂依赖的有效方法。美沙酮和丁丙诺啡是世界范围内最常用于替代治疗的阿片类药物,纳曲酮作为一种阿片受体的拮抗剂用于阻断治疗。研究数据显示维持疗法比脱毒疗法疗效更好,但是,存在长期用药剂量的安全性问题,包括对药物的直接反应和滥用风险。对美沙酮和丁丙诺啡(单独使用或与纳曲酮合用)的研究揭示了剂量与效应的关系,以及最佳的用药方案。研究数据提示,在呼吸抑制(过量)和对心血管的直接作用方面丁丙诺啡较美沙酮风险更低。丁丙诺啡,作为一种部分激动剂,可能比美沙酮或者海洛因等完全激动剂的滥用倾向更小。本文提供的数据说明在阿片依赖的个体上丁丙诺啡的滥用风险较美沙酮的更低。最近的数据提示,在阿片依赖和非依赖的使用者中,丁丙诺啡/纳曲酮合用的滥用潜力低于丁丙诺啡单独使用。

OPIOID AGONIST SUBSTITUTION THERAPIES:COMPARATIVE SAFETY AND ABUSE LIABILITY

Opioid maintenance therapies are an efficacious approach for the treatment of opium,heroin and pharmaceutical opioid dependence. Methadone and buprenorphine are the most common agonist substitution therapies in use worldwide,and naltrexone,an opioid antagonist,is used as a blocking treatment. Data indicate that maintenance treatment produces better outcomes compared to detoxification approaches. However,there are safety concerns related to long-term dosing that include the direct response to drugs and risks of misuse and diversion due to their abuse liability. Data will be presented from studies on methadone and buprenorphine (alone and in combination with naloxone) demonstrating the relationship between dose and efficacy outcomes which inform optimal dosing strategies. Data indicate that the relative risks related to respiratory depression (and overdose) and direct cardiac effects are lower for buprenorphine than for methadone. Buprenorphine,a partial agonist,may have less abuse liability than a full agonist,such as methadone or heroin,but still possesses abuse potential. Data will be presented revealing the lower abuse risk of buprenorphine in opioid dependent individuals compared to methadone,and recent data indicating decreased abuse potential of the buprenorphine/naloxone combination compared to buprenorphine alone in opioid-dependent and non-dependent users will be presented.