Global patterns of opioid use and dependence: harms to populations, interventions, and future action
Global patterns of opioid use and dependence: harms to populations, interventions, and future action
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DOI：
10.1016/s0140-6736(19)32229-9
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发表时间：
2019-10-26
期刊：
影响因子：
168.9
通讯作者：
Larney, Sarah
中科院分区：
文献类型：
--
作者：
Degenhardt, Louisa;Grebely, Jason;Larney, Sarah
我们总结了阿片类药物的医学用途、与这些药物的医疗外使用和依赖相关的危害以及用于解决这些危害的广泛干预措施的证据。据《全球疾病、伤害和风险因素负担研究》估计，2017年，有4050万人依赖阿片类药物（95%不确定区间为3430万至4790万），10.09万人（105 800至11.36万人）死于阿片类药物过量。阿片类激动剂治疗在减少非法阿片类药物使用和改善多种健康和社会结果方面非常有效，例如，通过降低总体死亡率和主要死亡原因，包括过量使用、自杀、艾滋病毒、丙型肝炎病毒和其他伤害。数学模型表明，扩大OAT的使用并使人们继续接受治疗，包括在监狱中，可以在20年内（与没有OAT相比）避免肯塔基州7.7%、基辅10.7%和德黑兰25.9%的中位数死亡，德黑兰和基辅的效果更大是因为艾滋病毒死亡率的降低，因为在这些环境中注射吸毒者中艾滋病毒的流行率更高。其他干预措施在有效性和患者可接受性方面有不同的证据，通常影响的结果比OAT更窄。其他有效干预措施侧重于预防与阿片类药物有关的伤害。尽管有强有力的证据表明，改善类阿片依赖者的健康和福祉的一系列干预措施是有效的，但覆盖率很低，即使在高收入国家也是如此。治疗质量可能不太理想，将医疗外阿片类药物使用和依赖定为刑事犯罪可能对个人、社会和经济造成相当大的伤害。建议采用其他政策框架，以人权和公共卫生为基础，不将吸毒视为犯罪行为，并设法在人口一级减少与毒品有关的伤害。
We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40.5 million people were dependent on opioids (95% uncertainty interval 34.3-47.9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7.7% of deaths in Kentucky, 10.7% in Kiev, and 25.9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.