Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework
Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework
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DOI：
10.1111/1468-0009.12470
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发表时间：
2020-08-18
影响因子：
6.6
通讯作者：
Sherman, Susan G.
中科院分区：
文献类型：
--
作者：
Park, Ju Nyeong;Rouhani, Saba;Sherman, Susan G.
政策要点本文重新定义了我们对阿片类药物流行的理解，并提出了解决这一流行病的社会根源的六项战略。为了长期成功地降低与毒品有关的死亡率，政策制定者和公共卫生领导人应与吸毒者发展伙伴关系，纳入减少危害干预措施，并扭转数十年来的毒品刑事化政策。背景药物过量是美国伤害相关死亡的主要原因。合成阿片类药物，主要是非法芬太尼及其类似物，在2016年的相关死亡率超过了处方阿片类药物和海洛因。不幸的是，干预措施未能充分应对当前的阿片类药物流行浪潮，往往忽略了有过毒品使用经历的人的声音。每一次过量死亡都是一系列政策失败和失去减少危害的机会的结果。方法在本文中，我们对阿片类药物文献进行了范围界定，以提出一个新的框架，旨在更直接地将社会决定因素纳入我们对这一国家紧急状态的理解。“过量用药风险连续体”框架是我们对全球证据基础的综合，并以当代理论、模型和政策为基础，这些理论、模型和政策已在国内外成功应用。从长远来看，降低过量用药风险将需要扩大创新和全面的解决方案，这些解决方案是通过与吸毒者建立伙伴关系而设计的，根植于减少危害。结论在没有认识到完整的药物使用连续体和社会决定因素的作用的情况下，目前对药物过量的反应将继续加剧他们试图解决的问题。
Policy PointsThis article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug-related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. Context Drug overdose is the leading cause of injury-related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. Methods In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The "continuum of overdose risk" framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. Findings De-escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. Conclusions Without recognizing the full drug-use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.