A Public Health Strategy for the Opioid Crisis
A Public Health Strategy for the Opioid Crisis
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DOI：
10.1177/0033354918793627
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发表时间：
2018-11-01
影响因子：
3.3
通讯作者：
Sherman, Susan G.
中科院分区：
文献类型：
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作者：
Saloner, Brendan;McGinty, Emma E.;Sherman, Susan G.
药物过量现在是美国伤害死亡的主要原因。大多数过量死亡涉及阿片类药物，其中包括处方药，海洛因和非法芬太尼。目前的数据显示，过量用药危机影响到所有人口群体，目前非裔美国人的过量用药率上升最快。我们提供了一个公共卫生的角度，可用于动员全面的地方，州和国家对阿片类药物危机的反应。我们认为，从公共卫生的角度来看，制定危机需要考虑多种因素的相互作用，包括结构性因素（如贫困和种族主义），疼痛管理不足，以及难以获得成瘾治疗和减少伤害的服务（如注射器服务）。我们提出了一个新的有害阿片类药物使用的生态框架，为改善公共卫生和临床实践提供了多项建议，包括改进数据收集以指导资源分配，采取措施增加更安全的处方，减少耻辱运动，增加减少伤害和治疗的支出，刑事司法政策改革，以及与受控物质相关的监管变化。关注这些机会提供了对过量和相关危害产生可衡量和持续影响的最大机会。
Drug overdose is now the leading cause of injury death in the United States. Most overdose fatalities involve opioids, which include prescription medication, heroin, and illicit fentanyl. Current data reveal that the overdose crisis affects all demographic groups and that overdose rates are now rising most rapidly among African Americans. We provide a public health perspective that can be used to mobilize a comprehensive local, state, and national response to the opioid crisis. We argue that framing the crisis from a public health perspective requires considering the interaction of multiple determinants, including structural factors (eg, poverty and racism), the inadequate management of pain, and poor access to addiction treatment and harm-reduction services (eg, syringe services). We propose a novel ecological framework for harmful opioid use that provides multiple recommendations to improve public health and clinical practice, including improved data collection to guide resource allocation, steps to increase safer prescribing, stigma-reduction campaigns, increased spending on harm reduction and treatment, criminal justice policy reform, and regulatory changes related to controlled substances. Focusing on these opportunities provides the greatest chance of making a measured and sustained impact on overdose and related harms.