Harm reduction in the USA: the research perspective and an archive to David Purchase.
Harm reduction in the USA: the research perspective and an archive to David Purchase.
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DOI：
10.1186/s12954-017-0178-6
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发表时间：
2017-07-26
影响因子：
4.4
通讯作者：
Des Jarlais DC
中科院分区：
文献类型：
--
作者：
Des Jarlais DC
美国减少危害的历史导致了一些最重要的治疗药物使用障碍的方法的发展，例如美沙酮和丁丙诺啡治疗阿片使用障碍。然而，在美国，实施和扩大减少危害的行动面临着强烈的政治阻力。这种抵抗根植于历史上对特定精神活性药物的妖魔化，这些药物与污名化的种族/族裔群体有关。随着1981年获得性免疫缺陷综合征(AIDS)的发现，减少危害不仅对治疗药物使用障碍变得重要，而且对减少血液传播感染也变得重要。然而，在1980年代强效可卡因流行的背景下，很难实施任何似乎“容忍”吸毒的方案。直到20世纪80年代末，美国的州和地方才开始实施注射器交换计划。在主要来自州和地方政府的资金和北美注射器交换网络(Nasen)的支持下，美国现在大约有200个注射器交换项目。研究表明，这些方案在减少注射吸毒者(PWID)中的人类免疫缺陷病毒(HIV)传播方面非常有效。美国的这些计划还为吸毒者提供许多额外的服务，包括分发避孕套、转介到药物滥用治疗、艾滋病毒、丙型肝炎病毒(丙型肝炎病毒)、乙肝病毒(乙肝)咨询和检测、过量教育和纳洛酮分发，以逆转过量服药。目前，美国正在经历阿片类药物/海洛因流行，吸毒者过量死亡人数大幅增加。这种流行病的大部分发生在该国的郊区和农村，没有减少危害的服务。减少危害和减少危害研究目前面临的挑战包括将服务扩展到郊区和农村地区，以及关于如何有效和高效地处理丙型肝炎病毒传播和过量用药的实施科学。最重要的是，需要继续进行研究努力，以减少精神活性药物使用的耻辱。虽然政治上的反对仍在继续，但减少危害活动人士和研究人员在共同核心价值观的基础上发展了一种高度有效的伙伴关系。本文的在线版本(doi：10.1186/s12954-0170178-6)包含补充材料，授权用户可以使用。
The history of harm reduction in the USA has led to the development of some of the most important methods for treating persons for drug use disorders, such as methadone and buprenorphine for opiate use disorder. However, there has been fierce political resistance to implementation and scale-up of harm reduction in the USA. This resistance is rooted in historical demonization of particular psychoactive drugs that were associated with stigmatized racial/ethnic groups. With the discovery of acquired immunodeficiency syndrome (AIDS) in 1981, harm reduction became important not only for treating substance use disorders, but for reducing transmission of blood-borne infection. However, within the context of the crack cocaine epidemic in the 1980s, it was very difficult to implement any programs that appeared to “condone” drug use. It was not until the late 1980s that syringe exchange programs began at the state and local level in the USA. With funding primarily from state and local governments and the support of the North American Syringe Exchange Network (NASEN), there are now approximately 200 programs for syringe exchange in the USA. Research has shown that these programs have been extremely effective in reducing human immunodeficiency virus (HIV) transmission among persons who inject drugs (PWID). The programs in the USA also offer many additional services for drug users, including condom distribution, referrals to substance abuse treatment, HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) counseling and testing, overdose education and naloxone distribution to reverse for overdose. Currently, the USA is experiencing an opioid/heroin epidemic, with significant increases in overdose deaths among drug users. Much of this epidemic is occurring in suburban and rural of the country without harm reduction services. The current challenges for harm reduction and harm reduction research involve expansion of services to suburban and rural areas and implementation science on how to effectively and efficiently address HCV transmission and overdose. Most importantly, continued research efforts are needed to reduce the stigma of psychoactive drug use. While political opposition continues, harm reduction activists and researchers have developed a highly effective partnership based on a common core values. The online version of this article (doi:10.1186/s12954-017-0178-6) contains supplementary material, which is available to authorized users.
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