New directions in the treatment of opioid withdrawal

[摘要] The treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with mu-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and a2-adrenergic receptor agonists (eg, clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (mu-opioid receptor agonism) and tizanidine (alpha 2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.

[关键词] MEDICATION-ASSISTED TREATMENT;DOUBLE-BLIND;USE DISORDER;BUPRENORPHINE-NALOXONE;EXTENDED-RELEASE;UNITED-STATES;CHRONIC PAIN;DRUG;GABAPENTIN;PLACEBO