A Population Health Approach to America's Opioid Epidemic
A Population Health Approach to America's Opioid Epidemic
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DOI：
10.1097/nor.0000000000000521
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发表时间：
2019-03-01
影响因子：
0.7
通讯作者：
Allread, Virginia
中科院分区：
文献类型：
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作者：
Salmond, Susan;Allread, Virginia
美国正处于全国性的公共卫生紧急状态：阿片类药物滥用和滥用的流行病被称为美国历史上最致命的药物危机。本文回顾了阿片类药物流行的现状，过去30-40年可能导致流行的趋势，以及解决流行病的人口健康方法。流行病的概念是从人口健康的角度来看，上游和中游的角度侧重于预防和下游的角度，以获得循证干预措施和最大限度地提高健康，无论使用或放弃。在急性护理的背景下，这种方法将包括对患者进行阿片类药物使用和其他成瘾风险因素的筛查，使用阿片类药物保留镇痛剂，以及在没有阿片类药物的情况下解决疼痛和疼痛缓解的后续护理。对于需要成瘾治疗的个人，提出了渐进主义哲学。渐进主义认识到行为改变的渐进性，并建议在克服成瘾的过程中沿着通过减少伤害来最大限度地提高健康和功能的策略。在社区内开展工作，解决造成类阿片相关物质使用障碍的广泛因素也至关重要。
The United States is in the midst of a nationwide public health emergency: an epidemic of opioid misuse and abuse that has been called the deadliest drug crisis in American history. This article reviews the current status of the opioid epidemic, the trends over the last 30-40 years that may have contributed to the epidemic, and a population health approach to addressing the epidemic. The epidemic is conceptualized from a population health perspective-an upstream and midstream perspective focusing on prevention and a downstream perspective targeting access to evidence-based interventions and maximizing health whether using or abstaining. Within the context of acute care, this approach will include patient screening for opioid use and other risk factors for addiction, use of opioid-sparing analgesics, and follow-up care that addresses pain and pain relief without opioids. For individuals who need addiction treatment, a gradualism philosophy is put forward. Gradualism recognizes the incremental nature of behavior change and recommends strategies to maximize health and functioning-through harm reduction-at all points along the journey to overcome addiction. Working within communities to address the broad factors that contribute to opioid-related substance use disorder is also essential.