The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: a qualitative analysis.
The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: a qualitative analysis.
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DOI：
10.1186/s13011-022-00480-4
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发表时间：
2022-07-21
影响因子：
3.3
通讯作者：
Li, Jianghong
中科院分区：
文献类型：
--
作者：
Dickson-Gomez, Julia;Krechel, Sarah;Spector, Antoinette;Weeks, Margaret;Ohlrich, Jessica;Montaque, H. Danielle Green;Li, Jianghong
关键词：
从20世纪90年代开始，处方阿片类药物（PO）的非医疗使用成为一个重大的公共卫生危机。为了应对阿片类药物依赖和致命中毒率的上升，制定了减少处方、转移和非医疗使用PO的措施，包括处方药监测计划（PDMP）、疼痛诊所法律、处方持续时间限制、对处方过多PO的医生进行纪律处分，以及PO滥用威慑制剂的出现。本文探讨了这些政策的意外影响，描述了为什么使用阿片类药物的人从PO过渡到注射或海洛因/芬太尼的使用。我们对来自康涅狄格州、肯塔基州和威斯康星州三个州的农村、城市和郊区的148名非医学使用处方阿片类药物、芬太尼或海洛因的人进行了深入采访。对使用阿片类药物（PWUO）的人的采访集中在他们如何开始使用阿片类药物以及他们从PO使用到海洛因，芬太尼或注射药物使用的任何过渡。大多数参与者报告说，他们开始使用PO，用于医疗或非医疗目的。他们描述了随着耐受性的增加，需要服用更多的PO或改用海洛因或芬太尼。随着越来越多的政策被通过以限制阿片类药物处方，参与者注意到医生不太可能开处方或补充PO。这导致街上PO的稀缺，加速了海洛因或芬太尼的转变。这些转变可能会增加过量和HIV/HCV感染的风险。仔细分析人们如何以及为什么说他们从PO过渡到海洛因或芬太尼，揭示了政策变化的许多意想不到的危害，以防止过度处方和转移。结果强调了减轻政策变化造成的危害的重要性。
Beginning in the 1990s, nonmedical use of prescription opioids (POs) became a major public health crisis. In response to rising rates of opioid dependence and fatal poisonings, measures were instituted to decrease the prescription, diversion, and nonmedical use of POs including prescription drug monitoring programs (PDMPs), pain clinic laws, prescription duration limits, disciplining doctors who prescribed an excessive number of POs, and the advent of abuse deterrent formulations of POs. This paper explores the unintended effects of these policies in the descriptions of why people who use opioids transitioned from PO to injection or heroin/fentanyl use. We conducted 148 in-depth-interviews with people who use prescription opioids nonmedically, fentanyl or heroin from a rural, urban and suburban area in three states, Connecticut, Kentucky and Wisconsin. Interviews with people who use opioids (PWUO) focused on how they initiated their opioid use and any transitions they made from PO use to heroin, fentanyl or injection drug use. The majority of participants reported initiating use with POs, which they used for medical or nonmedical purposes. They described needing to take more POs or switched to heroin or fentanyl as their tolerance increased. As more policies were passed to limit opioid prescribing, participants noticed that doctors were less likely to prescribe or refill POs. This led to scarcity of POs on the street which accelerated the switch to heroin or fentanyl. These transitions likely increased risk of overdose and HIV/HCV infection. A careful analysis of how and why people say they transitioned from PO to heroin or fentanyl reveals many unintended harms of policy changes to prevent overprescribing and diversion. Results highlight the importance of mitigating harms that resulted from policy changes.
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影响因子：
6.7
作者：
Coplan PM;Chilcoat HD;Butler SF;Sellers EM;Kadakia A;Harikrishnan V;Haddox JD;Dart RC
通讯作者：
Dart RC
影响因子：
5.3
作者：
Alpert, Abby;Powell, David;Pacula, Rosalie Liccardo
通讯作者：
Pacula, Rosalie Liccardo
对患者和提供者对阿片类药物使用障碍的治疗药物的观点的系统评价。
影响因子：
3.9
作者：
Cioe K;Biondi BE;Easly R;Simard A;Zheng X;Springer SA
通讯作者：
Springer SA
影响因子：
4.4
作者：
Ali, Mir M.;Dowd, William N.;Novak, Scott P.
通讯作者：
Novak, Scott P.
影响因子：
4.2
作者：
Dasgupta, Nabarun;Creppage, Kathleen;Proescholdbell, Scott K.
通讯作者：
Proescholdbell, Scott K.