The use of pharmacological treatments for opioid use disorders, including methadone, buprenorphine and naltrexone has been associated with a reduction in mortality compared with illicit opioid use. However, these treatments can also contribute significantly to the risk of death. The opioid agonists methadone and buprenorphine achieve clinical efficacy in patients with an opioid use disorder through suppressing craving and diminishing the effectiveness of illicit opioid doses, while the antagonist naltrexone blocks the action of opioids. Pharmacological differences between opioid pharmacotherapies then create different temporal patterns of protection and mortality risk, different risks of relapse to illicit opioid use, and variations in direct and indirect toxicity, which are revealed in clinical and epidemiological studies. Induction onto methadone and the cessation of oral naltrexone treatment are associated with an elevated risk of opioid poisoning, which is not apparent in patients treated with buprenorphine or sustained-release naltrexone. Beyond drug-related mortality, these pharmacotherapies can impact a participant’s risk of death. Buprenorphine may also have some advantages over methadone in patients with depressive disorders or cardiovascular abnormalities. Naltrexone, which is also commonly prescribed to manage problem alcohol use, may reduce deaths in chronic co-alcohol users. Understanding these pharmacologically driven patterns then guides the judicious choice of drug and dosing schedule and the proactive risk management that is crucial to minimising the risk of death in treatment.

与非法使用阿片类药物相比，使用药物治疗阿片类药物使用障碍（包括美沙酮、丁丙诺啡和纳曲酮）与死亡率降低有关。然而，这些治疗也会显着增加死亡风险。阿片类激动剂美沙酮和丁丙诺啡通过抑制对阿片类药物使用障碍的渴望和降低非法阿片类药物剂量的有效性，从而在阿片类药物使用障碍患者中实现临床疗效，而拮抗剂纳曲酮则阻断阿片类药物的作用。阿片类药物治疗之间的药理学差异会产生不同的保护和死亡风险的时间模式、非法阿片类药物使用复发的不同风险以及直接和间接毒性的变化，这些在临床和流行病学研究中得到揭示。诱导使用美沙酮和停止口服纳曲酮治疗与阿片类药物中毒风险升高有关，这在接受丁丙诺啡或缓释纳曲酮治疗的患者中并不明显。除了与药物相关的死亡率外，这些药物疗法还会影响参与者的死亡风险。对于患有抑郁症或心血管异常的患者，丁丙诺啡也可能比美沙酮具有一些优势。纳曲酮也常用于管理有问题的酒精使用，可能会减少长期酗酒者的死亡人数。了解这些药理学驱动的模式然后指导药物和给药时间表的明智选择以及主动风险管理，这对于最大限度地降低治疗中的死亡风险至关重要。