Introduction: Opioid agonist treatment (OAT) is the first-line treatment for opioid dependence. Currently available OAT options comprise oral (methadone and morphine) and sublingual (buprenorphine) routes of administration. In Switzerland and some other countries, severely opioid-dependent individuals with insufficient response to oral or sublingual OAT are offered heroin-assisted treatment (HAT), which involves the provision of injected or oral medical heroin (diacetylmorphine [DAM]). However, many patients on treatment with injectable DAM (i-HAT) suffer from injection-related problems such as deteriorated vein status, ulcerations, endocarditis, and abscesses. Other patients who do not respond to oral OAT do not inject but snort opioids, and are not eligible for i-HAT. For this population, there is no other short-acting OAT with rapid onset of action available unless they switch to injecting, which is associated with higher risks. Nasal DAM (n-HAT) could be an alternative treatment option suitable for both populations of patients. Methods: We present a case series of 3 patients on i-HAT who successfully switched to n-HAT. Results/Conclusions: This is the first description of the clinical use of the nasal route of administration for HAT. n-HAT may constitute an important risk-reduced rapid-onset alternative to i-HAT. In particular, it may be suited for patients with injection-related complications, or noninjecting opioid-dependent patients failing to respond to oral OAT.
Eur Addict Res

中文翻译：

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严重阿片依赖患者的鼻阿片激动剂治疗：病例系列

介绍：阿片类激动剂治疗（OAT）是阿片类药物依赖的一线治疗。目前可用的 OAT 选择包括口服（美沙酮和吗啡）和舌下（丁丙诺啡）给药途径。在瑞士和其他一些国家，对口服或舌下 OAT 反应不足的严重阿片类药物依赖者提供海洛因辅助治疗 (HAT)，其中包括注射或口服医用海洛因（二乙酰吗啡 [DAM]）。然而，许多接受注射 DAM (i-HAT) 治疗的患者会出现与注射相关的问题，例如静脉状态恶化、溃疡、心内膜炎和脓肿。其他对口服 OAT 没有反应的患者不注射但吸食阿片类药物，因此不符合 i-HAT 的条件。对于这个人群，除非他们改用注射，否则没有其他可快速起效的短效 OAT，这与更高的风险相关。鼻 DAM (n-HAT) 可能是适合这两类患者的替代治疗选择。方法：我们展示了 3 名 i-HAT 患者成功转为 n-HAT 的病例系列。结果/结论：这是对 HAT 经鼻给药的临床应用的首次描述。n-HAT 可能构成 i-HAT 的一种重要的降低风险的快速起效替代品。特别是，它可能适用于有注射相关并发症的患者，或对口服 OAT 无反应的非注射阿片类药物依赖患者。
欧洲瘾君子水库