A crisis of opioids and the limits of prescription control: United States
A crisis of opioids and the limits of prescription control: United States
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DOI：
10.1111/add.14394
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发表时间：
2019-01-01
期刊：
影响因子：
6
通讯作者：
Gordon, Adam, I
中科院分区：
文献类型：
--
作者：
Kertesz, Stefan G.;Gordon, Adam, I
在美国，涉及阿片类药物的成瘾和过量死亡人数增加，促使人们采取了一系列旨在减少阿片类药物风险的举措，其中包括与阿片类药物处方有关的几项措施。政策分析奖学金提供了一个概念框架，以帮助理解这种反应。在2011年之前，监管机构和制药商的“政策垄断”允许并鼓励高水平的阿片类药物处方。面对由官员、思想领袖、记者和有共同信念的利益集团组成的“宣传联盟”引起公众注意的不利后果，这种宽容的政策土崩瓦解。该联盟制定了更谨慎的处方方案，激励原本稳定的患者非自愿终止阿片类药物，从而导致伤害报告。它强调剂量减少，无论结果如何，在某种程度上反映了先前的重点是最大限度地减少疼痛评分，无论结果如何。本分析的核心是，政策不可能是全面合理的;相反，它们是由一系列行动者和机构产生的，这些行动者和机构在吸收复杂数据、客观评估数据和以迭代、快速反应的方式掌握必要资源的能力方面受到限制。强有力的处方控制与弱有力的疼痛和成瘾治疗扩张之间的不平衡证实了政策学者的“有限理性”概念。结果并不理想：阿片类药物处方减少，但对疼痛患者的伤害和过量死亡人数增加。美国的政策制定者可以通过更彻底地与现在同时应对疼痛和成瘾的患者、家庭和社区接触来修改课程。
A rise in addiction and overdose deaths involving opioids in the United States has spurred a series of initiatives focused on reducing opioid risks, including several related to prescription of opioids in care of pain. Policy analytical scholarship provides a conceptual framework to assist in understanding this response. Prior to 2011, a 'policy monopoly' of regulators and pharmaceutical manufacturers allowed and encouraged high levels of opioid prescribing. This permissive policy fell apart in the face of adverse outcomes brought to public attention by an 'advocacy coalition' consisting of officials, thought leaders, journalists and interest groups who shared common beliefs. This coalition has generated a more cautious prescribing regimen that has incentivized involuntary termination of opioids in otherwise stable patients, with resultant reports of harm. Its emphasis on dose reduction, regardless of outcomes, mirrors in some ways the prior focus on minimizing pain scores, regardless of outcomes. Central to the present analysis is that policies cannot be comprehensively rational; rather, they emerge from a range of actors and agencies constrained in their ability to assimilate complex data, evaluate the data objectively and to command necessary resources in an iterative, rapid response fashion. The imbalance between strong prescription control and weak pain and addiction treatment expansion exemplifies the policy scholar's notion of 'bounded rationality'. Results have been suboptimum: opioid prescriptions have fallen, but harms to pain patients and overdose deaths have risen. US policymakers could revise the course through a more thoroughgoing engagement with patients, families and communities now coping with both pain and addiction.