Overdose Prevention Centers: An Essential Strategy to Address the Overdose Crisis.
Overdose Prevention Centers: An Essential Strategy to Address the Overdose Crisis.
复制标题
药物过量预防中心：解决药物过量危机的基本策略。
作者：
E. Samuels;Dennis Bailer;Annajane Yolken
2021年，美国有超过107 000人死于药物过量，1较2020年增加15%。涉及可卡因的死亡增加了23%，涉及甲基苯丙胺或其他兴奋剂的死亡增加了34%。1无家可归者2以及美洲印第安人或美洲原住民、黑人和拉丁美洲人的死亡率增长最快。近年来，已经扩大了经证实的减少危害战略，以减少过量死亡。减少伤害是一种接近和照顾吸毒者的方式，以人们的尊严，人性和自主权为中心，以减少与物质使用相关的伤害。它使用实用的战略，满足人们的需要，以改善个人和社区的福祉和健康。几十年来对减少危害战略的强有力研究，特别是注射器服务和纳洛酮分配，表明这些战略与降低发病率，死亡率和传染病传播以及改善个人健康结果和服务参与有关，并且具有较高的成本效益。使用过量预防中心（OPC）是一种基于证据的减少危害干预措施，直到最近，在美国还没有。OPC有时被称为监督消费中心，是人们可以在受监控的环境中消费预先获得的药物的地方，工作人员可以在过量的情况下立即进行干预。使用中心的人可以提供或链接到概括性服务，包括其他减少伤害的服务，基本需求（例如，住房或食物），医疗服务和成瘾治疗。在欧洲、澳大利亚和加拿大的10个国家有120多个OPC。模型的范围从同行运行的设施，移动的单位和医疗模型与成瘾治疗计划共处。无论哪种模式，所有OPC都提供了一个安全的、非判断性的环境，工作人员经过培训，可以在过量事件中进行干预，并提供个性化的支持和服务联系。4，5研究发现，OPC与使用中心和中心所在社区的个人的利益相关。4，5 OPC与减少过量死亡、物质使用相关危害、4，5 OPCs也被发现与增加治疗参与、定期中心使用有关，但与增加毒品贩运、以前不使用毒品的人开始使用药物或恢复使用药物无关。对2014年至2021年运营的未经批准的美国OPC进行的评估发现，中心使用率很高，没有任何过量死亡。6对于周边社区，OPC已被证明与减少公共药物消费，减少药物消费设备和犯罪有关。4，5 2021年11月，OnPoint NYC在美国开设了第一家政府批准的OPC。Harocopos等人7描述了在手术的前2个月内在OnPoint NYC的2个OPC的患者遭遇。有600多人访问了近6000次。在使用OPCs的人中，超过三分之一的参与者没有住所，少数参与者（17.8%）有自己的房间或公寓，四分之三的参与者报告说，否则他们会在公共或半公共场所使用药物。工作人员进行了125次干预，以减轻过量风险，其中包括使用阿片类药物的个人的氧气或纳洛酮管理，以及水合作用。
In 2021, more than 107 000 people died from a drug overdose in the US,1 a 15% increase from 2020. Deaths involving cocaine increased 23%, and deaths involving methamphetamines or other stimulants increased 34%.1 Death rates are increasing the most rapidly among people experiencing homelessness2 and among American Indian or Native American, Black, and Latinx individuals.3 These staggering numbers demonstrate an urgent need for immediate action. In recent years, there has been expansion of proven harm reduction strategies to reduce overdose deaths. Harm reduction is a way of approaching and caring for people who use drugs that centers people’s dignity, humanity, and autonomy to reduce harms associated with substance use. It uses practical strategies to meet people where they are to improve individual and community well-being and health. Decades of robust research on harm reduction strategies, specifically syringe services and naloxone distribution, demonstrate that these strategies are associated with reduced morbidity, mortality, and transmission of infectious diseases and improved individual health outcomes and services engagement and that they have high cost-effectiveness. The use of overdose prevention centers (OPCs) is an evidence-based harm-reduction intervention that, until recently, has not been available in the US. OPCs, which are sometimes referred to as supervised consumption centers, are places where people can consume preobtained drugs in a monitored setting where staff can immediately intervene in the event of an overdose. People who use the centers can be provided or linked to wraparound services, including other harm reduction services, basic needs (eg, housing or food), medical services, and addiction treatment. There are more than 120 OPCs in 10 countries across Europe, Australia, and Canada. Models range from peer-run facilities to mobile units and medical models colocated with addiction treatment programs. Regardless of model type, all OPCs provide a safe, nonjudgmental setting with staff trained to intervene in the event of an overdose and provide individualized support and linkage to services.4,5 Research has found that OPCs are associated with benefits for individuals who use the centers and neighborhoods where the centers are located.4,5 OPCs have been found to be associated with reduced overdose deaths, substance use–related harms, and all-cause mortality among people who use drugs and to be cost-effective.4,5 OPCs have also been found to be associated with increased treatment engagement, with regular center use, but not with increased drug trafficking, initiation of substance use among people who did not previously use drugs, or resumed use among people in recovery. An evaluation of an unsanctioned US OPC that operated from 2014 to 2021 found high rates of center use without any overdose deaths.6 For surrounding neighborhoods, OPCs have been shown to be associated with reduced public drug consumption, litter of drug consumption equipment, and crime.4,5 In November 2021, OnPoint NYC opened the first government-sanctioned OPCs in the US. Harocopos et al7 describe patient encounters at OnPoint NYC’s 2 OPCs in the first 2 months of operation. There were nearly 6000 visits by more than 600 individuals. Among those who used the OPCs, more than one-third of participants were unhoused, a minority of participants (17.8%) had their own room or apartment, and three-quarters of participants reported that they would otherwise have used drugs in a public or semipublic location. Staff intervened 125 times to mitigate overdose risk, which included oxygen or naloxone administration for individuals using opioids, and hydration, + Related article