America's Opioid Epidemic: Supply and Demand Considerations
America's Opioid Epidemic: Supply and Demand Considerations
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DOI：
10.1213/ane.0000000000002388
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发表时间：
2017-11-01
影响因子：
5.7
通讯作者：
Schumacher, Mark A.
中科院分区：
文献类型：
--
作者：
Clark, David J.;Schumacher, Mark A.
美国正处于阿片类药物流行病之中，其特点是积极的处方做法，高度流行的阿片类药物滥用，以及处方和非法阿片类药物过量相关死亡率的上升。在过去几年中，医疗和普通公众对处方阿片类药物的使用变得更加谨慎，但缺乏减少我们对处方阿片类药物依赖的综合战略。通过减少对这些药物的不必要获取，同时执行减少需求的措施来应对这一流行病，将是任何全面解决办法的重要组成部分。关键的供应方措施包括避免过度开药、减少转移和通过改变药物配方阻止滥用。重要的需求方措施围绕着教育患者和临床医生关于阿片类药物过度使用的陷阱以及避免不必要地暴露于这些药物的方法。麻醉师凭借其在使用这些药物方面的专业知识以及在手术前后指导阿片类药物使用方面的地位，在减少患者暴露于阿片类药物和提供有关适当使用的教育方面发挥着重要作用。除了可以立即采取的许多步骤外，旨在了解疼痛和阿片类药物滥用之间相互作用的临床和基础研究对于确定这些强效止痛药在临床实践中的最佳使用至关重要。
America is in the midst of an opioid epidemic characterized by aggressive prescribing practices, highly prevalent opioid misuse, and rising rates of prescription and illicit opioid overdose-related deaths. Medical and lay public sentiment have become more cautious with respect to prescription opioid use in the past few years, but a comprehensive strategy to reduce our reliance on prescription opioids is lacking. Addressing this epidemic through reductions in unnecessary access to these drugs while implementing measures to reduce demand will be important components of any comprehensive solution. Key supply-side measures include avoiding overprescribing, reducing diversion, and discouraging misuse through changes in drug formulations. Important demand-side measures center around educating patients and clinicians regarding the pitfalls of opioid overuse and methods to avoid unnecessary exposure to these drugs. Anesthesiologists, by virtue of their expertise in the use of these drugs and their position in guiding opioid use around the time of surgery, have important roles to play in reducing patient exposure to opioids and providing education about appropriate use. Aside from the many immediate steps that can be taken, clinical and basic research directed at understanding the interaction between pain and opioid misuse is critical to identifying the optimal use of these powerful pain relievers in clinical practice.