为研究和评估阿片类药物戒断建立一个研究议程
1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The lancet. Psychiatry
|March 23, 2024
概括
阿片类药物危机需要更好的治疗方法,但对阿片类药物戒断的理解是有限的. 需要一个国际研究议程来定义戒断和开发用于阿片类药物使用障碍的新药.
科学领域:
- 公共卫生 公共卫生
- 药理学 药理学是指药理学的学科.
- 成 药物 药物 药物 药物
背景情况:
- 阿片类药物危机仍然是一个重大的全球卫生挑战.
- 目前针对阿片类药物使用障碍 (OUD) 的治疗主要集中在治疗阿片类药物戒断症状上.
- 尽管有大量治疗抑郁症的药物,但50年来只开发了五种OUD,这表明投资不足,可能是由于对戒断的理解不足.
研究的目的:
- 突出了解阿片类药物戒断综合征的重大差距.
- 争辩国际研究议程的必要性,以推进OUD治疗.
- 确定改善阿片类药物戒断管理的关键研究目标.
主要方法:
- 审查当前的理解和定义和测量阿片类药物戒断的挑战.
- 识别戒断症状学,表型和影响因素中的关键知识缺口.
- 确定可操作的研究目标.
主要成果:
- 缺乏对阿片类药物戒断的准确定义的共识,具有众多的症状和测量尺度.
- 对戒断的不准确理解导致不准确的严重程度评估和评估药物疗效的挑战.
- 最近FDA对阿片类药物戒断的指示激发了对药物开发的兴趣.
结论:
- 一个明确的,基于共识的阿片类药物戒断定义至关重要.
- 了解戒断各种阿片类药物 (特别是芬太尼) 和同时暴露的情况至关重要.
- 解决发现的研究缺口是必要的,以促进OUD药物开发的创新.
相关概念视频
Analgesia and Pain Management
614
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
614
Drug Abuse and Addiction: Pharmacological Phenomena
469
Drug dependence, abuse, and addiction are complex phenomena that can precipitate various abnormal states. Physical dependence refers to a state of pharmacological adaptation to a drug. This adaptation often results in tolerance—a reduced response to the drug after repeated administrations. When the drug use is abruptly stopped, withdrawal symptoms occur due to the body's need to readjust from the pharmacologically induced imbalance. However, tolerance and withdrawal symptoms do not...
469
Opioid Analgesics: Synthetic and Semisynthetic Opioids
287
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
287
Opioid Receptors: Overview
776
Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
776
Opioid Analgesics: Morphine and Other Natural Cogeners
244
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
244
Substance Use Disorders Affecting Sleep
166
Substance use disorders involve a pattern of using drugs more extensively than intended and continuing use despite harmful consequences. This includes legal substances like alcohol and nicotine, as well as illegal drugs. These disorders often involve both physical and psychological dependence, reflecting compulsive use of substances that significantly alter thoughts, feelings, and behaviors, contributing to a major public health issue.
Understanding the concepts of physical dependence,...
Understanding the concepts of physical dependence,...
166


