Toward an Improved Multi-Criteria Drug Harm Assessment Process and Evidence-Based Drug Policies.
Toward an Improved Multi-Criteria Drug Harm Assessment Process and Evidence-Based Drug Policies.
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DOI：
10.3389/fphar.2018.00898
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发表时间：
2018
影响因子：
5.6
通讯作者：
Dubljević V
中科院分区：
文献类型：
--
作者：
Dubljević V
国际药物管制体系和国家立法中的药物目录最近受到批评，因为其科学依据不足。与合法可用的物质（例如烟草）相比，与某些药物（例如大麻）的非医疗用途相关的法律危害可以说已经超过了其生理和社会危害，这促使一些州探索替代性监管政策，类似于荷兰的毒品制度。其他合法处方药物（例如兴奋剂）引起了人们对“优于健康”用途的兴趣激增，而其他药物（例如阿片类药物）则在北美引起了巨大的流行。基于证据的多标准药物危害量表（MCDHS）已被提议作为根据药物实际危害程度制定政策的一种方式。事实上，该量表在多个政策领域产生了巨大影响，并且已广泛应用于跨学科研究的不同领域。然而，MCDHS 的某些方面仍然存在争议。例如，数据的生成方式被批评为存在“专家偏见”。本文回顾了使用 MCDHS 提供的证据的优点和缺点。此外，作者认为 MCDHS 的缺点可以通过提供方法改进来解决。其中包括 (1) 将吸毒危害与滥用危害区分开来，(2) 将吸毒者、药剂师和全科医生的观点与专家评估相结合，以及 (3) 重点关注药物子集，以便在不混合吸毒的不同社会背景的情况下进行比较。该文件最后概述了 MCDHS 的物质子集特定扩展以及被认为产生最多争议的四个领域的相关政策建议：阿片类药物的非医疗用途、兴奋剂的“学习援助”用途、含尼古丁产品的趋势变化以及大麻的医疗和娱乐用途的监管。
Drug scheduling within the international system of drug control and national legislation has been recently criticized as having insufficient footing in scientific evidence. The legal harms related to non-medical uses of certain drugs (e.g., cannabis) have arguably exceeded their physiological and social harmfulness compared to legally available substances (e.g., tobacco), which prompted some states to explore alternative regulation policies, similar to the drug regime in the Netherlands. Other legally prescribed drugs (e.g., stimulants) created a surge of interest for “better than well” uses, while yet others (e.g., opioids) caused an epidemic of dramatic proportions in North America. The evidence-based multi-criteria drug harm scale (MCDHS) has been proposed as a way of grounding policy in the actual degree of harmfulness of drugs. Indeed, the scale has had great ramifications in several areas of policy, and it has been used extensively in distinct lines of interdisciplinary research. However, some aspects of MCDHS remain disputed. For example, the way the data has been generated has been criticized as suffering from “expert bias.” This article reviews strengths and weaknesses of evidence provided with the use of MCDHS. Furthermore, the author argues that the shortcomings of MCDHS can be resolved by offering methodological improvements. These include (1) dissociating the harms of use from harms of abuse, (2) adding the perspectives of people who use drugs, pharmacists, and general medical practitioners along with the expert assessments, and (3) focusing on subsets of drugs to allow for comparison without mixing different social contexts of drug use. The paper concludes with outlines of substance subset-specific extensions of the MCDHS and related policy proposals in the four areas identified as generating the most controversy: non-medical use of opioids, “study aid” uses of stimulants, shifting trends in nicotine containing products, and regulation of medical and recreational uses of cannabis.
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