Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings : Harm Reduction in Outpatient Addiction Treatment.
Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings : Harm Reduction in Outpatient Addiction Treatment.
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将危害减少纳入门诊阿片类药物使用障碍治疗环境：门诊成瘾治疗的损害减少。
DOI：
10.1007/s11606-021-06904-4
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发表时间：
2021-12
影响因子：
5.7
通讯作者：
Bagley SM
中科院分区：
文献类型：
--
作者：
Taylor JL;Johnson S;Cruz R;Gray JR;Schiff D;Bagley SM
阿片类药物使用障碍（OUD）越来越被认为是一种慢性、复发性脑部疾病，其治疗应与其他慢性疾病一起纳入初级保健机构。然而，戒除所有非处方药物的使用仍然是许多门诊、初级保健治疗方案中唯一期望的目标。这对继续使用药物的患者构成了参与的障碍，这些患者可能面临持续使用药物并发症的高风险，如人类免疫缺陷病毒（HIV）、丙型肝炎病毒（HCV）、浅表和深层组织感染以及过量使用。减少伤害旨在减少物质使用的负面后果，并提供了一个替代禁欲作为一个单一的目标。将减少伤害原则纳入初级保健治疗环境，可以支持与正在使用药物的患者接触的方案，并促进提供循证筛查和预防服务。这篇叙述性综述的目的是描述将基于证据的减少伤害原则和干预措施整合到门诊、以初级保健为基础的OUD治疗环境中的策略。我们将为提供者和项目提供具体的工具，包括支持更安全注射实践的策略，评估在持续使用药物的情况下持续使用阿片类药物使用障碍的风险和益处，促进非污名化的项目文化，并解决持续使用药物的特殊人群的需求，包括青少年、父母和家庭。在线版本包含补充材料，可在10.1007/s11606-021-06904-4获得。
Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families. The online version contains supplementary material available at 10.1007/s11606-021-06904-4.
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