The Global Diversion of Pharmaceutical DrugsNon-medical use and diversion of psychotropic prescription drugs in North America: a review of sourcing routes and control measures
The Global Diversion of Pharmaceutical DrugsNon-medical use and diversion of psychotropic prescription drugs in North America: a review of sourcing routes and control measures
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DOI：
10.1111/j.1360-0443.2010.03092.x
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发表时间：
2010-12-01
期刊：
影响因子：
6
通讯作者：
Bouchard, Martin
中科院分区：
文献类型：
--
作者：
Fischer, Benedikt;Bibby, Meagan;Bouchard, Martin
北美是世界上受管制精神活性处方药（PPD;例如处方阿片类药物、苯二氮卓类药物、兴奋剂）消费水平最高的地区，近年来，重点人群的非医疗使用和相关危害（例如发病率、死亡率）不断上升。虽然这些“使用”问题的决定因素、特征和影响越来越多地得到充分记录，但对非医疗用PPD使用的“供应"方面知之甚少，其中大部分是通过”转移“作为主要来源途径而得到促进的。本文提供了一个选择审查的现象PPD转移在北美，也考虑到干预措施和政策implications.MethodsA的概念和实证审查的选择同行和非同行评议的研究文献1991年至2010年专注于PPD转移在北美covered.ResultsThe现象PPD转移是异质性的。特别是在普通人群中，大部分用于非医疗用途的PPD是从朋友或家人那里获得的。其他PPD转移路线涉及“双重doctoring”或“处方购物”;街头毒品市场;药物盗窃，处方欺诈或欺诈;以及PPD购买从internet.ConclusionsThe不同的性质和异质性使PPD转移一个复杂和困难的目标干预。处方监测计划（PMP）似乎减少了PPD的总体使用，但其对减少转移或非医疗使用的影响尚不清楚。执法不太可能有效地达到PPD转移。有效的减少可能需要减少PPD的总消费量，尽管这需要在不影响良好医疗（例如疼痛）护理标准的情况下实现。
AimsNorth America features some of the world's highest consumption levels for controlled psychoactive prescription drugs (PPDs; e.g. prescription opioids, benzodiazepines, stimulants), with non-medical use and related harms (e.g. morbidity, mortality) rising in key populations in recent years. While the determinants, characteristics and impacts of these 'use' problems are increasingly well documented, little is known about the 'supply' side of non-medical PPD use, much of which is facilitated by 'diversion' as a key sourcing route. This paper provides a select review of the phenomenon of PPD diversion in North America, also considering interventions and policy implications.MethodsA conceptual and empirical review of select-peer- and non-peer-reviewed research literature from 1991 to 2010 focusing upon PPD diversion in North America was conducted.ResultsThe phenomenon of PPD diversion is heterogeneous. Especially among general populations, a large proportion of PPDs for non-medical use are obtained from friends or family members. Other PPD diversion routes involve 'double doctoring' or 'prescription shopping'; street drug markets; drug thefts, prescription forgeries or fraud; as well as PPD purchases from the internet.ConclusionsThe distinct nature and heterogeneity make PPD diversion a complex and difficult target for interventions. Prescription monitoring programs (PMPs) appear to reduce overall PPD use, yet their impact on reducing diversion or non-medical use is not clear. Law enforcement is unlikely to reach PPD diversion effectively. Effective reduction will probably require reductions in overall PPD consumption volumes, although such will need to be accomplished without compromising standards of good medical (e.g. pain) care.