丁丙诺啡和丁丙诺啡/纳洛酮(BUP)新批准用于阿片类药物依赖的办公室治疗。联邦和非联邦监管机构,国家和国际研究人员,国家专业组织,参与监测的研究人员,阿片类药物治疗方案和制药业开会,综合和传播实用信息,以指导培训,实践,监测,这些药物的监管和评估工作。我们对文献进行了回顾,培训课程和实践指南以及最近完成的委托手稿,或者仍在进行中,BUP治疗的研究或现场经验。共识过程产生了15个声明:(1)联邦政府应收集与阿片类药物相关的死亡和发病率的基线数据,以评估BUP对公共卫生的影响,(2)团体实践的患者限制应适用于个别医生,而不是团体实践,(3和4)需要电话和基于互联网的医生和药剂师支持,(5)向阿片类药物依赖患者提供心理社会服务的临床医生应了解BUP的作用,(6)阿片类药物依赖患者应指示出现诱导轻度戒断,(7)现有的药物滥用治疗中心指南提供了合理的诱导方案,(8)医师应准备使用BUP诱导的辅助药物,(9)在诱导期间,患者必须有医生或护士,(10)需要同时提供咨询和支持服务,(11)没有适当的后续成瘾治疗的排毒导致快速复发,并且不如维持有效,(12)应使用良好的临床实践对依赖阿片类药物的孕妇进行治疗,包括专科成瘾护理和产前护理,(13)BUP诱导和退出治疗可能受益于不同的付款指定,(14)带回家的药物选择应根据患者的需求量身定制,(15)有必要在独特的患者人群中进行临床和政策研究。
Buprenorphine and buprenorphine/naloxone (BUP) are newly approved for office-based treatment of opioid dependence. Federal and non-federal regulatory and monitoring agencies, national and international researchers, national professional organizations, researchers involved in monitoring, opioid treatment programs and the pharmaceutical industry met to synthesize and disseminate practical information to guide training, practice, monitoring, regulation and evaluation efforts with these medications. We performed a review of the literature, training curricula and practice
guidelines and commissioned manuscripts describing recently completed, or still in progress, studies or field experiences with BUP treatment. A
consensus process generated fifteen statements: (1) The federal government should collect baseline data on opioid-related deaths and morbidity to assess the effect of BUP on public health, (2) the patient limit for group practices should apply to individual physicians rather than group practices, (3 and 4) telephone and Internet-based physician and pharmacist support is needed, (5) clinicians who provide psychosocial services to opioid dependent patients should be informed of the role of BUP, (6) opioid-dependent patients should be instructed to present for induction in mild withdrawal, (7) the existing Center for Substance Abuse Treatment
guidelines provide a reasonable induction protocol, (8) physicians should be prepared to use ancillary medications with BUP induction, (9) a physician or nurse must be available to the patient during the induction period, (10) concurrent counseling and support services are necessary, (11) detoxification without appropriate followup addiction treatment leads to rapid relapse and is not as effective as maintenance, (12) pregnant opioid-dependent women should be treated using good clinical practice including specialist addiction care and prenatal care, (13) BUP induction and withdrawal treatment may benefit from different designations for payment, (14) take-home medication options should be tailored to patients\' needs, (15) there is a need for clinical and policy research in unique patient populations.