Клиническое применение агонистов опиатов для лечения опийной наркомании

Москва

В начало...

Обобщая публикации об эффективности поддерживающей терапии метадоном, следует признать, что регулярный прием препарата в рамках индивидуально разработанных лечебных программ позволяет значительно уменьшить остроту медико-социальных проблем опийной наркомании. В связи с тем что собственно аддиктивные синдромы как психофизиологический феномен практически не меняют своей модальности, поддерживающее лечение метадоном может рассматриваться не как разновидность противорецидивной терапии (в связи с отсутствием истинной ремиссии), а как паллиативная лечебная мера либо как переходный этап к полному воздержанию. Поддерживающая терапия метадоном является альтернативой лечебным походам, основанным на приеме налтрексона, и ценность данного метода, вероятно, может повышаться при его применении в отношении пациентов с неблагоприятным и относительно неблагоприятным прогнозом болезни [2]. Кроме того, следует заметить, что в соответствии с психофармакологическим профилем препарата метадон даже в сочетании с психотерапией вне зависимости от применяемой дозы вряд ли способен, вопреки некоторым представлениям [50, 86], эффективно влиять на психопатологические проявления опийной наркомании, тяжесть которых во многом определяет сам характер этой болезни.

Близок к метадону по химической структуре и фармакологическим свойствам L-альфаацетилметадол (LAAM). В опытах на животных показано [29], что LAAM при хроническом приеме снижает чувствительность к морфину и фентанилу и повышает чувствительность к налтрексону, налорфину и налбуфину, что указывает на его агонистическую активность в отношении опиатных рецепторов и возникновение толерантности. LAAM обладает еще более продолжительными, чем у метадона, характеристиками элиминации, что в ряде случаев позволяет осуществлять его прием с периодичностью в несколько дней [25, 95]. По показателям частоты ВИЧ-инфицирования (что, как говорилось выше, в настоящее время рассматривается в качестве важнейшего критерия эффективности лечебных программ для употребляющих наркотики [9]), а также по другим критериям лечебной эффективности терапия с использованием LAAM расценивается как сопоставимая с ММТ [68, 70, 73, 97].

В настоящее время дискуссии о терапевтических возможностях метадона продолжаются.

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