Extending a lifeline to people with HIV and opioid use disorder during the war in Ukraine.
Extending a lifeline to people with HIV and opioid use disorder during the war in Ukraine.
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DOI：
10.1016/s2468-2667(22)00083-4
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发表时间：
2022-05
影响因子：
50
通讯作者：
Madden, Lynn M.
中科院分区：
文献类型：
--
作者：
Altice, Frederick L.;Bromberg, Daniel J.;Dvoriak, Sergii;Meteliuk, Anna;Pykalo, Iryna;Islam, Zahedul;Azbel, Lyu;Madden, Lynn M.
在空袭警报声中，奥莱克桑德在一座被炸弹袭击的乌克兰北方城市中航行。他正在去诊所的路上，为他的阿片类药物使用障碍收集美沙酮-这是他自2016年以来定期进行的旅行。然而，这一次的情况却大不相同。3天前，他将妻子和孩子送到利沃夫寻求安全，并与其他20名男子一起住在他的大楼地下室，该大楼兼作防空洞。供水中断，食物日益匮乏。昨天，他的医生给他发了一条30分钟的短信，让他在紧急警报不太常见的时候去拿美沙酮。医生开了10天的药，Oleksander松了一口气。他不知道随着危机的恶化，他会得到多少。在COVID-19大流行之前，他每天都去领取美沙酮，但自大流行开始以来，已允许带回家的剂量，使他更容易工作和照顾家人。在未被占领的乌克兰，美沙酮和丁丙诺啡都可作为治疗类阿片使用障碍的药物。虽然很高兴收到今天的美沙酮供应，但Oleksander要求增加供应，以防万一俄罗斯军队接管。尽管乌克兰卫生部刚刚发布了新的指导方针，允许30天的供应，他的医生不愿意，因为他需要为他的其他病人或可能逃离东部的新病人保留足够的。他的医生还担心供应链中断和提供更多阿片类药物使用障碍的药物。全国各地的治疗方案及其工作人员正在努力满足患者的需求。一些医生正在减少剂量以延长供应，而另一些医生则在分发他们所拥有的药物，因为他们不确定新药物何时到达。供应链中断对患者的影响是巨大的。每隔几天逐渐减少剂量将导致戒断症状引起的身体和情绪上的不舒服副作用延长。然而，突然用完药物会导致戒断症状的严重副作用。在任何一种情况下，阿片类药物的戒断症状不仅会加剧战争的压力和焦虑，而且许多患者可能会再次使用可注射阿片类药物，增加他们过量使用，皮肤和软组织感染以及传播血液传播病毒的风险，如艾滋病毒或丙型肝炎病毒。在所有接受美沙酮治疗的人中，约有一半也在接受艾滋病毒治疗，1停用美沙酮可能导致艾滋病毒药物停药率很高，这可能加速艾滋病毒的进展，或者在继续冒险感染艾滋病毒的情况下，将艾滋病毒传染给他人。
Oleksander navigates a bomb-shelled northern Ukrainian city between air raid sirens. He is on his way to the clinic to collect methadone for his opioid use disorder—a trip he has made regularly since 2016. However, this time the situation is quite different. 3 days earlier he sent his wife and children to Lviv for safety and has been living with 20 other men in the basement of his building, which doubles as a bomb shelter. Water has been disrupted and food is increasingly scarce. Yesterday, his doctor texted him a 30-min window to pick up his methadone, when emergency sirens are less common. The doctor dispenses a 10-day supply and Oleksander is relieved. He was not sure how much he would receive with the crisis worsening. Before the COVID-19 pandemic, he went to collect his methadone daily but, since the pandemic began, take-home doses have been permitted, making it easier for him to work and take care of his family. In non-occupied Ukraine, both methadone and buprenorphine are available as medications for opioid use disorder. Although grateful to receive today’s supply of methadone, Oleksander asks for an increased supply, just in case the Russian army takes over. Even though Ukraine’s Ministry of Health has just released new guidance allowing for a 30-day supply, his doctor is reluctant because he needs to keep enough for his other patients or for new patients that might be fleeing the east. His doctor is also concerned about disruptions in the supply chain and delivery of more medications for opioid use disorder.Treatment programmes and their staff throughout the country are struggling to navigate the needs of their patients. Some doctors are reducing dosages to prolong supplies while others are dispensing what they have because they are uncertain when new medications will arrive. The consequences of a disrupted supply chain to patients are substantial. Tapering the dose every few days will result in a prolonged period of physically and emotionally uncomfortable side-effects from withdrawal symptoms. However, running out of medication abruptly will result in serious side-effects from withdrawal symptoms. In either case, withdrawal symptoms from opioids will not only accentuate the stresses and anxieties of war, but many patients could then relapse to injectable opioids, elevating their risk for overdose, skin and soft tissue infections, and transmission of blood-borne viruses such as HIV or hepatitis C virus. Approximately half of all people on methadone are also being treated for HIV, 1 and the discontinuation of methadone could result in high rates of discontinuation from HIV medications, which could accelerate progression of HIV or, in the case of ongoing HIV risk-taking, transmit HIV to others.