The Impact of High-Potency Synthetic Opioids on Pharmacotherapies for Opioid Use Disorder: A Scoping Review.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI:10.1097/ADM.0000000000001356
Oluwole Jegede, Joao P De Aquino, Connie Hsaio, Ebony Caldwell, Melissa C Funaro, Ismene Petrakis, Srinivas B Muvvala
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Abstract

Background: The clinical implications of high potency synthetic opioids (HPSO) on medications for opioid use disorder (MOUDs) are not well understood. Although pharmacological interactions are plausible, the clinical significance of such interaction has not been systematically elucidated. This scoping review investigates the relationship between HPSO exposure and various MOUD treatment outcomes.

Methods: We followed PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews) for scoping reviews with extensive a priori search strategy of databases: MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL, and Cochrane.

Results: From 9149 studies, 34 fulfilled the inclusion criteria. Synthesized data reveal several critical insights: First, there is a variable but high occurrence (38%-80%) of HPSO usage among individuals with MOUDs. Second, MOUDs are linked to a decreased risk of overdoses and deaths associated with HPSO. Third, HPSO consumption is correlated with the risk of precipitated withdrawal when starting buprenorphine. Fourth, low-dose buprenorphine is being recognized as one method to avoid moderate withdrawal symptoms prior to treatment. Lastly, significant gaps exist in human experimental data concerning the effects of HPSO on key factors critical for treating OUD-craving, withdrawal symptoms, and pain.

Conclusions: Current evidence supports MOUD safety and effectiveness in reducing nonmedical opioid use. Further research is needed to explore HPSO's influence on the acute factors preceding nonmedical opioid use, such as cravings, withdrawal symptoms, and pain. This research could inform the optimization of MOUD dosing strategies. Achieving consensus and harmonizing data across clinical and research protocols could diminish variability, enhancing our understanding of HPSOs effect on MOUD treatment outcomes.

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高能合成类阿片对阿片类药物使用障碍药物疗法的影响:范围综述》。
背景:高活性合成阿片类药物(HPSO)对阿片类药物使用障碍(MOUDs)的临床影响尚不十分清楚。虽然药理相互作用是合理的,但这种相互作用的临床意义尚未得到系统阐明。本范围综述调查了 HPSO 暴露与各种 MOUD 治疗结果之间的关系:方法:我们按照 PRISMA-ScR(系统性综述和荟萃分析扩展范围综述的首选报告项目)进行范围综述,并事先对数据库进行了广泛的检索:MEDLINE、EMBASE、PsycINFO、Web of Science、CINAHL 和 Cochrane:从 9149 项研究中,有 34 项符合纳入标准。综合数据揭示了几个重要的观点:首先,MOUD 患者使用 HPSO 的情况各不相同,但发生率很高(38%-80%)。其次,MOUDs 与 HPSO 相关的过量使用和死亡风险降低有关。第三,在开始使用丁丙诺啡时,服用 HPSO 与骤然戒断的风险相关。第四,低剂量丁丙诺啡被认为是避免治疗前出现中度戒断症状的一种方法。最后,关于 HPSO 对治疗 OUD 关键因素--渴求、戒断症状和疼痛--的影响,人类实验数据还存在很大差距:目前的证据支持 MOUD 在减少非医疗阿片类药物使用方面的安全性和有效性。需要进一步研究 HPSO 对非医疗使用阿片类药物前的急性因素(如渴望、戒断症状和疼痛)的影响。这项研究可为 MOUD 剂量策略的优化提供依据。在临床和研究方案中达成共识并统一数据可以减少变异性,从而加深我们对 HPSOs 对 MOUD 治疗结果影响的理解。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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