Opioid use disorder (OUD) is a chronic, relapsing condition, often associated with legal, interpersonal, and employment problems. Medications demonstrated to be effective for OUD are methadone (a full opioid agonist), buprenorphine (a partial agonist), and naltrexone (an opioid antagonist). Methadone and buprenorphine act by suppressing opioid withdrawal symptoms and attenuating the effects of other opioids. Naltrexone blocks the effects of opioid agonists. Oral methadone has the strongest evidence for effectiveness. Longer duration of treatment allows restoration of social connections and is associated with better outcomes. Treatments for OUD may be limited by poor adherence to treatment recommendations and by high rates of relapse and increased risk of overdose after leaving treatment. Treatment with methadone and buprenorphine has the additional risk of diversion and misuse of medication. New depot and implant formulations of buprenorphine and naltrexone have been developed to address issues of safety and problems of poor treatment adherence. For people with OUD who do not respond to these treatments, there is accumulating evidence for supervised injectable opioid treatment (prescribing pharmaceutical heroin). Another medication mode of minimizing risk of overdose is take-home naloxone. Naloxone is an opioid antagonist used to reverse opioid overdose, and take-home naloxone programs aim to prevent fatal overdose. All medication-assisted treatment is limited by lack of access and by stigma. In seeking to stem the rising toll from OUD, expanding access to approved treatment such as methadone, for which there remains the best evidence of efficacy, may be the most useful approach.

中文翻译：

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阿片类药物使用障碍的药物治疗

阿片类药物使用障碍 (OUD) 是一种慢性复发性疾病，通常与法律、人际关系和就业问题有关。已证明对 OUD 有效的药物是美沙酮（一种全阿片类激动剂）、丁丙诺啡（一种部分激动剂）和纳曲酮（一种阿片类拮抗剂）。美沙酮和丁丙诺啡通过抑制阿片类药物戒断症状和减弱其他阿片类药物的作用来发挥作用。纳曲酮阻断阿片类激动剂的作用。口服美沙酮有最有力的证据证明其有效性。更长的治疗时间可以恢复社会联系，并与更好的结果相关。OUD 的治疗可能因治疗建议的依从性差、复发率高和停止治疗后用药过量的风险增加而受到限制。使用美沙酮和丁丙诺啡进行治疗具有转移和滥用药物的额外风险。已开发出丁丙诺啡和纳曲酮的新储库和植入剂制剂，以解决安全性问题和治疗依从性差的问题。对于对这些治疗没有反应的 OUD 患者，有越来越多的证据支持在监督下注射阿片类药物治疗（处方药用海洛因）。另一种将过量风险降至最低的药物模式是带回家的纳洛酮。纳洛酮是一种阿片类拮抗剂，用于逆转阿片类药物过量服用，而带回家的纳洛酮计划旨在防止致命的过量服用。所有药物辅助治疗都受到无法访问和耻辱的限制。为了阻止 OUD 造成的死亡人数上升，扩大获得批准的治疗方法（如美沙酮）的机会，