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Assessment of Co-Occurring Substance Use During Opiate Treatment Programs in the United States. 在美国阿片类药物治疗项目中共同发生的物质使用评估。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa009
Mirinda Ann Gormley, Courtney T Blondino, DaShaunda D H Taylor, Elizabeth Lowery, James S Clifford, Benjamin Burkart, Whitney C Graves, Elizabeth C Prom-Wormley, Juan Lu

The effectiveness of opiate treatment programs (OTPs) can be significantly influenced by co-occurring substance use, yet there are no standardized guidelines for assessing the influence of co-occurring substance use on treatment outcomes. In this review, we aim to provide an overview on the status of the assessment of co-occurring substance use during participation in OTPs in the United States. We searched 4 databases-MEDLINE/PubMed, EMBASE, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)-from database inception to November 2018 to select relevant publications on OTPs that assessed participants' co-occurring substance use. We used a standardized protocol to extract study, intervention, and co-occurring substance use characteristics. Methodological quality was assessed using the Quality in Prognosis Studies tool. Of the 3,219 titles screened, 614 abstracts and 191 full-text original publications were assessed, leaving 85 eligible articles. Co-occurring substance use was most often assessed during opioid treatments using combined (pharmacological and behavioral) (n = 57 studies) and pharmacological (n = 25 studies) interventions. Cocaine, alcohol, marijuana, and benzodiazepines were frequently measured, while amphetamines and tobacco were rarely assessed. Great variation existed between studies in the timing and measurement of co-occurring substance use, as well as definitions for substances and polysubstance/polydrug use. Inconsistencies in the investigation of co-occurring substance use make comparison of results across studies challenging. Standardized measures and consensus on research on co-occurring substance use is needed to produce the evidence required to develop personalized treatment programs for persons using multiple substances and to inform best-practice guidelines for addressing polydrug use during participation in OTPs.

阿片类药物治疗方案(OTPs)的有效性可能受到同时发生的物质使用的显著影响,但目前还没有标准化的指南来评估同时发生的物质使用对治疗结果的影响。在这篇综述中,我们的目的是概述美国参加OTPs期间共发生物质使用的评估状况。我们检索了4个数据库- medline /PubMed、EMBASE、PsychINFO和护理和相关健康文献累积索引(CINAHL)-从数据库建立到2018年11月,以选择评估参与者共同发生的药物使用的otp相关出版物。我们使用标准化的方案来提取研究、干预和共同发生的物质使用特征。采用预后研究质量工具评估方法学质量。在筛选的3,219个标题中,评估了614篇摘要和191篇全文原始出版物,留下85篇符合条件的文章。在阿片类药物治疗期间,使用联合(药理学和行为)(n = 57项研究)和药理学(n = 25项研究)干预措施最常评估共同发生的物质使用情况。经常测量可卡因、酒精、大麻和苯二氮卓类药物,而很少评估安非他明和烟草。在同时发生的物质使用的时间和测量以及物质和多物质/多药物使用的定义方面的研究存在很大差异。同时发生的物质使用调查的不一致性使得跨研究结果的比较具有挑战性。需要对同时发生的药物使用的研究采取标准化措施并达成共识,以便为使用多种药物的人制定个性化治疗方案提供所需的证据,并为参与otp期间处理多种药物使用的最佳实践指南提供信息。
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引用次数: 4
The Role of Evidence in the US Response to the Opioid Crisis. 证据在美国应对阿片类药物危机中的作用。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa004
Joshua M Sharfstein, Yngvild Olsen

The National Institutes of Health is investing hundreds of millions of dollars into new research on opioids. As these studies yield insights and results, their results will have to change policy and practice before they can bend the curve of the epidemic. However, the United States does not have a strong track record of translating evidence on drug policy into action. Three reasons for the translation gap are the historical legacy of drugs in the United States, vested interests, and politics. Researchers can become engaged in policy and political processes to strengthen the US response.

美国国立卫生研究院正在投资数亿美元用于阿片类药物的新研究。由于这些研究产生了见解和结果,它们的结果必须改变政策和做法,才能扭转这一流行病的曲线。然而,美国在将有关毒品政策的证据转化为行动方面并没有良好的记录。造成翻译差距的三个原因是美国药物的历史遗产、既得利益和政治。研究人员可以参与政策和政治进程,以加强美国的应对措施。
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引用次数: 2
Policing Practices and Risk of HIV Infection Among People Who Inject Drugs. 警务实践与注射吸毒者感染艾滋病毒的风险。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa010
Pieter Baker, Leo Beletsky, Liliana Avalos, Christopher Venegas, Carlos Rivera, Steffanie A Strathdee, Javier Cepeda

Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a "shooting gallery"). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.

禁毒执法是注射吸毒者(PWID)健康的结构性决定因素。警察与注射吸毒者之间的街头冲突(如没收注射器、人身攻击)与健康危害有关,但这些关系尚未得到系统评估。我们进行了一项系统性文献综述,以评估警务对吸毒者感染人体免疫缺陷病毒(HIV)风险的影响。我们筛选了 MEDLINE、社会学数据库和灰色文献,以查找 1981 年至 2018 年 11 月期间发表的、包含 HIV 感染/危险行为和街头治安遭遇估计值的研究。我们从所有符合条件的研究中提取并总结了定量研究结果。我们筛选了 8201 篇摘要,审阅了 175 篇全文,并纳入了来自 9 个国家(加拿大、中国、印度、马来西亚、墨西哥、俄罗斯、泰国、乌克兰和美国)的 27 项符合条件的分析。变量和终点选择的异质性排除了荟萃分析。在 5 项(19%)研究中,感染艾滋病病毒的吸毒者与注射器被没收、因害怕警察而不愿购买/携带注射器、因警察在场而匆忙注射、害怕被捕、因种植毒品而被捕以及身体虐待有显著关联。21项(78%)研究发现,治安管理措施与注射吸毒相关的艾滋病风险行为(如共用注射器、使用 "射击场")有关。在 9 项(33%)研究中,治安与注射吸毒者避免使用减少伤害服务有关,包括注射器交换、美沙酮维持治疗和安全消费设施。有证据表明,治安影响了注射吸毒者感染艾滋病毒的风险,但低收入环境中的代表性不足。要遏制与注射相关的艾滋病毒风险,就必须采取更多的结构性干预措施。方法上的统一可以促进关于警察作为人口健康决定因素的作用的知识生成。
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引用次数: 0
The Influence of Co-Occurring Substance Use on the Effectiveness of Opiate Treatment Programs According to Intervention Type. 同时发生物质使用对阿片治疗方案干预类型有效性的影响。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa005
Courtney T Blondino, Mirinda Ann Gormley, DaShaunda D H Taylor, Elizabeth Lowery, James S Clifford, Benjamin Burkart, Whitney C Graves, Juan Lu, Elizabeth C Prom-Wormley

This systematic review describes the influence of co-occurring substance use on the effectiveness of opiate treatment programs. MEDLINE/PubMed, Embase, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from database inception to November 28, 2018, to identify eligible opioid treatment studies in the United States that assessed the relationship between co-occurring substance use and treatment outcome (i.e., opioid abstinence and treatment retention). A total of 34 eligible studies were included. Overall, co-occurring substance use was associated with negative treatment outcomes regardless of intervention type. However, patterns varied by substance and intervention type. In particular, co-occurring use of cocaine or marijuana with opioids was associated with reduced treatment retention and opioid abstinence regardless of intervention type. Co-occurring use of amphetamines, compared with no use or reduced use of amphetamines, decreased treatment retention. Co-occurring use of alcohol was both positively and negatively associated with treatment outcomes. One study reported a significant positive association between sedative use and opioid abstinence. Generally, findings suggest that combined interventions reported better health outcomes compared with pharmacological or behavioral intervention studies alone. The findings of this review emphasize the need to comprehensively study and address co-occurring substance use to improve opiate treatment programs.

本系统综述描述了共同发生的物质使用对阿片类药物治疗方案有效性的影响。从数据库建立到2018年11月28日,检索MEDLINE/PubMed、Embase、PsychINFO以及护理和联合健康文献累积索引,以确定美国符合条件的阿片类药物治疗研究,这些研究评估了共存物质使用与治疗结果(即阿片类药物戒断和治疗保留)之间的关系。共纳入34项符合条件的研究。总体而言,无论干预类型如何,共同发生的物质使用与负面治疗结果相关。然而,模式因物质和干预类型而异。特别是,可卡因或大麻与阿片类药物同时使用与治疗保留率降低和阿片类药物戒断有关,无论干预类型如何。与不使用或减少使用安非他明相比,同时使用安非他明降低了治疗效果。同时使用酒精与治疗结果呈正相关和负相关。一项研究报告了镇静剂使用与阿片类药物戒断之间的显著正相关。总的来说,研究结果表明,与单独的药物或行为干预研究相比,联合干预报告了更好的健康结果。本综述的结果强调需要全面研究和解决共同发生的物质使用,以改善阿片类药物治疗方案。
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引用次数: 7
The Evolving Overdose Epidemic: Synthetic Opioids and Rising Stimulant-Related Harms. 不断发展的过量流行病:合成阿片类药物和不断上升的兴奋剂相关危害。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa011
Christopher M Jones, Faraah Bekheet, Ju Nyeong Park, G Caleb Alexander

The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids (1999-2010), heroin (2011-2013), and illicit fentanyl and other synthetic opioids (2014-present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic, posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.

阿片类药物过量流行通常被描述为分三波发生,发病率和死亡率随着时间的推移而增加,主要来自处方阿片类药物(1999-2010年)、海洛因(2011-2013年)和非法芬太尼和其他合成阿片类药物(2014年至今)。然而,越来越多的合成类阿片混入非法药物供应,包括与可卡因和甲基苯丙胺等兴奋剂混合,以及与兴奋剂有关的死亡人数不断上升,反映了过量用药流行病的迅速演变性质,构成了紧迫和新的公共卫生挑战。我们综合了这些趋势背后的证据,考虑了诸如芬太尼和兴奋剂同时暴露的地点和方式等关键问题,并为关键利益相关者确定了如何最好地解决这些新出现的威胁以及过量流行的持续演变的行动。
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引用次数: 71
Prescription Drug Monitoring Programs and Prescription Opioid-Related Outcomes in the United States. 美国处方药监测项目和处方阿片类药物相关结果。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa002
Victor Puac-Polanco, Stanford Chihuri, David S Fink, Magdalena Cerdá, Katherine M Keyes, Guohua Li

Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.

处方药监测项目(PDMPs)是联邦和州政府应对阿片类药物流行的重要组成部分。关于PDMPs在减少处方阿片类药物相关不良后果方面的有效性的证据参差不齐。我们进行了一项系统综述,以检查PDMP在美国的实施是否与4个处方阿片类药物相关结果领域的变化有关:阿片类药物处方行为、阿片类药物转移和供应、阿片类药物相关发病率和物质使用障碍以及阿片类药物相关死亡。我们在Embase、Google Scholar、MEDLINE和Web of Science中搜索了符合条件的出版物。2009年至2019年间发表的29项研究符合纳入标准。在16项检查PDMPs和处方行为的研究中,11项发现实施PDMPs减少了处方行为。关于阿片类药物转移和供应的所有3项研究都报告了所检查结果的减少。在阿片类药物相关发病率和物质使用障碍领域,8项研究中有7项发现了与处方阿片类药物相关结果的关联。在阿片类药物相关死亡领域的8项研究中,有4项报告死亡率降低。尽管结果喜忧参半,但新出现的证据支持,国家PDMPs的实施减少了阿片类药物处方、阿片类药物的转移和供应,以及阿片类药物相关的发病率和物质使用障碍的结果。当检查PDMP特征时,强制性获取规定与处方行为、转移结果、住院率、物质使用障碍和死亡率的减少有关。结果领域之间证据基础的不一致是由于不同研究的分析方法,以及在某种程度上,不同州和不同时期实施的PDMP政策的异质性。
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引用次数: 30
Drug Use Disorders and Violence: Associations With Individual Drug Categories. 药物使用障碍和暴力:与个别药物类别的关联。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa006
Shaoling Zhong, Rongqin Yu, Seena Fazel

We conducted a systematic review that examined the link between individual drug categories and violent outcomes. We searched for primary case-control and cohort investigations that reported risk of violence against others among individuals diagnosed with drug use disorders using validated clinical criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We identified 18 studies published during 1990-2019, reporting data from 591,411 individuals with drug use disorders. We reported odds ratios of the violence risk in different categories of drug use disorders compared with those without. We found odds ratios ranging from 0.8 to 25.0 for most individual drug categories, with generally higher odds ratios among individuals with polydrug use disorders. In addition, we explored sources of between-study heterogeneity by subgroup and meta-regression analyses. Cohort investigations reported a lower risk of violence than case-control reports (odds ratio =  2.7 (95% confidence interval (CI): 2.1, 3.5) vs. 6.6 (95% CI: 5.1, 8.6)), and associations were stronger when the outcome was any violence rather than intimate partner violence (odds ratio = 5.7 (95% CI: 3.8, 8.6) vs. 1.7 (95% CI: 1.4, 2.1)), which was consistent with results from the meta-regression. Overall, these findings highlight the potential impact of preventing and treating drug use disorders on reducing violence risk and associated morbidities.

我们进行了一项系统回顾,检查了个别药物类别与暴力结果之间的联系。我们根据系统评价和荟萃分析指南的首选报告项目,搜索了主要病例对照和队列调查,这些调查使用经过验证的临床标准报告了被诊断为药物使用障碍的个体中对他人的暴力风险。我们确定了1990-2019年期间发表的18项研究,报告了来自591,411名药物使用障碍患者的数据。我们报告了不同类别药物使用障碍中暴力风险的比值比与非药物使用障碍的比值比。我们发现,大多数药物类别的比值比在0.8到25.0之间,多种药物使用障碍患者的比值比通常更高。此外,我们通过亚组和元回归分析探讨了研究间异质性的来源。队列调查报告的暴力风险低于病例对照报告(优势比= 2.7(95%置信区间(CI): 2.1, 3.5) vs. 6.6 (95% CI: 5.1, 8.6)),当结果是任何暴力而不是亲密伴侣暴力时,关联更强(优势比= 5.7 (95% CI: 3.8, 8.6) vs. 1.7 (95% CI: 1.4, 2.1)),这与meta回归的结果一致。总的来说,这些发现突出了预防和治疗药物使用障碍对减少暴力风险和相关发病率的潜在影响。
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引用次数: 21
Prevalence and Correlates of Providing and Receiving Assistance With the Transition to Injection Drug Use. 向注射吸毒过渡过程中提供和接受援助的流行程度及其相关性。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa008
Rachel E Gicquelais, Dan Werb, Charles Marks, Carolyn Ziegler, Shruti H Mehta, Becky L Genberg, Ayden I Scheim

Preventing the transition to injection drug use is an important public health goal, as people who inject drugs (PWID) are at high risk for overdose and acquisition of infectious disease. Initiation into drug injection is primarily a social process, often involving PWID assistance. A better understanding of the epidemiology of this phenomenon would inform interventions to prevent injection initiation and to enhance safety when assistance is provided. We conducted a systematic review of the literature to 1) characterize the prevalence of receiving (among injection-naive persons) and providing (among PWID) help or guidance with the first drug injection and 2) identify correlates associated with these behaviors. Correlates were organized as substance use behaviors, health outcomes (e.g., human immunodeficiency virus infection), or factors describing an individual's social, economic, policy, or physical environment, defined by means of Rhodes' risk environments framework. After screening of 1,164 abstracts, 57 studies were included. The prevalence of receiving assistance with injection initiation (help or guidance at the first injection) ranged 74% to 100% (n = 13 estimates). The prevalence of ever providing assistance with injection initiation varied widely (range, 13%-69%; n = 13 estimates). Injecting norms, sex/gender, and other correlates classified within Rhodes' social risk environment were commonly associated with providing and receiving assistance. Nearly all PWID receive guidance about injecting for the first time, whereas fewer PWID report providing assistance. Substantial clinical and statistical heterogeneity between studies precluded meta-analysis, and thus local-level estimates may be necessary to guide the implementation of future psychosocial and sociostructural interventions. Further, estimates of providing assistance may be downwardly biased because of social desirability factors.

防止过渡到注射吸毒是一项重要的公共卫生目标,因为注射吸毒者(PWID)有过量吸毒和感染传染病的高风险。开始注射药物主要是一个社会过程,通常涉及PWID援助。更好地了解这一现象的流行病学将为干预措施提供信息,以防止开始注射并在提供援助时加强安全性。我们对文献进行了系统回顾,以1)描述首次注射药物时接受(未注射者)和提供(PWID患者)帮助或指导的流行程度,2)确定这些行为的相关性。相关因素被组织为物质使用行为、健康结果(如人类免疫缺陷病毒感染)或描述个人社会、经济、政策或物理环境的因素,这些因素由Rhodes风险环境框架定义。在筛选了1164篇摘要后,纳入了57篇研究。开始注射时接受帮助(第一次注射时的帮助或指导)的流行率为74%至100% (n = 13个估计值)。曾经协助开始注射的流行率差异很大(范围,13%-69%;N = 13个估计)。注射规范、性/性别和其他被归类为罗兹社会风险环境的相关因素通常与提供和接受援助有关。几乎所有的未成年人都是第一次接受注射指导,而很少有未成年人报告提供帮助。研究之间的大量临床和统计异质性排除了荟萃分析,因此可能需要地方水平的估计来指导未来社会心理和社会结构干预措施的实施。此外,由于社会期望因素,对提供援助的估计可能会向下偏误。
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引用次数: 11
Prescription Opioid Use Among Populations of Reproductive Age: Effects on Fertility, Pregnancy Loss, and Pregnancy Complications. 处方阿片类药物在育龄人群中的使用:对生育能力、妊娠丢失和妊娠并发症的影响。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa007
Kerry S Flannagan, Lindsey A Sjaarda, Sunni L Mumford, Enrique F Schisterman

Prescription opioid use is common among men and women of reproductive age, including during assisted-reproduction procedures. Opioid use disorder and chronic use are associated with harms to fertility and pregnancy outcomes, but it is unclear whether these associations extend to common short-term patterns of prescription opioid use. We conducted a literature review using PubMed, Embase, Web of Science, and Scopus to identify studies of nonchronic, nondependent opioid use and reproductive endpoints including fertility, pregnancy loss, and pregnancy complications (i.e., preterm birth, birth weight, gestational diabetes, and hypertensive disorders of pregnancy). Seventeen studies were included. Although results of the studies suggest possible harms of short-term opioid use on fertility and pregnancy loss, methodologic limitations and the small number of studies make the literature inconclusive. This review highlights important data gaps that must be addressed to make conclusions about potential reproductive effects of short-term opioid use. These include the need for additional data on opioid use before clinically recognized pregnancy; accurate measurement of opioid exposure by multiple means with detailed information on the types and quantity of opioids used; assessment of important confounders, including opioid use indication, comorbidities, and use of other medications and substances; and studies of paternal opioid use, fertility, and pregnancy outcomes. A primary limitation of this review targeting studies of nonchronic opioid exposure is the possibility that selected studies included populations with unspecified chronic or dependent opioid use. Efforts to understand the impact of the prescription opioid epidemic should address potential reproductive harms of these medications among people of reproductive age.

处方阿片类药物的使用在育龄男性和女性中很常见,包括在辅助生殖过程中。阿片类药物使用障碍和慢性使用与生育和妊娠结局的危害有关,但尚不清楚这些关联是否延伸到处方阿片类药物使用的常见短期模式。我们使用PubMed、Embase、Web of Science和Scopus进行了文献综述,以确定非慢性、非依赖性阿片类药物使用和生殖终点的研究,包括生育力、妊娠丢失和妊娠并发症(即早产、出生体重、妊娠糖尿病和妊娠高血压疾病)。纳入了17项研究。虽然研究结果表明短期使用阿片类药物可能对生育和妊娠损失造成危害,但方法学的局限性和研究数量少使得文献不具有结论性。本综述强调了必须解决的重要数据缺口,以得出关于短期阿片类药物使用的潜在生殖影响的结论。其中包括需要在临床确认怀孕前获得阿片类药物使用的额外数据;通过多种手段准确测量阿片类药物暴露情况,并提供使用阿片类药物类型和数量的详细信息;评估重要混杂因素,包括阿片类药物使用指征、合并症和其他药物和物质的使用;以及父亲使用阿片类药物、生育能力和妊娠结局的研究。本综述针对非慢性阿片类药物暴露研究的主要局限性是所选研究可能包括未指明的慢性或依赖性阿片类药物使用人群。努力了解处方类阿片流行病的影响,应解决这些药物对育龄人群生殖的潜在危害。
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引用次数: 3
The Worldwide Opioid Pandemic: Epidemiologic Perspectives. 全球阿片类药物大流行:流行病学观点。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa012
David Celentano
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引用次数: 2
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