阿片类药物流行的数字:死亡率、研究结果和预防意义的元分析综述

Davoud Amiri, Ali Moghaddam
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摘要

在北美,特别是美国和加拿大,阿片类药物危机的特点是美沙酮的分配、过量死亡和转移日益增多,尽管最近的努力在一些地区有所下降。加拿大的阿片类处方药发放量在 2012 年之前一直在增加,之后安大略省等地区的阿片类处方药发放量大幅下降。2001-2016 年间,美国与阿片类药物相关的死亡人数增长了惊人的 345%,25-34 岁的人群深受其害。美国全国调查显示,8.9% 的 12 岁或以上美国人最近使用过非法药物,这进一步凸显了这一日益严重的流行病。研究将阿片类药物的销售与用药过量致死联系起来,凸显了不当处方做法的危险性。为解决这一问题,我们提倡药物辅助治疗 (MAT)、行为疗法和支持小组。接受与承诺疗法和动机访谈等消除耻辱感的干预措施已被证明是有效的。在费城和旧金山等城市观察到的一个一致模式表明,受毒品供应经济学的驱动,年轻的海洛因成瘾者往往会从药物阿片类药物转而吸食海洛因。为解决阿片类药物使用失调问题,初级保健已认识到 MAT 至关重要,并采用了新的创新模式,如多层次保健和利益相关者参与。然而,污名化和缺乏专业知识等障碍带来了挑战,突出表明迫切需要针对不同的初级保健环境制定完善的策略和模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Opioid Epidemic in Numbers: A Meta-Analytic Review of Mortality, findings, and Implications for Prevention
The opioid crisis in North America, particularly the United States and Canada, has been characterized by increasing methadone distribution, overdose deaths and diversion, although recent efforts have seen declines in some areas. Canada’s prescription opioid dispensing increased until 2012, after which areas such as Ontario saw significant declines. The United States experienced a staggering 345% increase in opioid-related deaths from 2001-2016, heavily affecting people aged 25-34. This growing epidemic is further highlighted by the U.S. National Survey, which shows that 8.9% of Americans aged 12 or older engaged in illicit drug use recently. Research links opioid sales to overdose deaths, highlighting the dangers of inappropriate prescription practices. To address this, Medication-Assisted Treatment (MAT), behavioral therapies and support groups are promoted. Anti-stigma interventions such as acceptance and commitment therapy and motivational interviewing have been shown to be effective. A consistent pattern observed in cities such as Philadelphia and San Francisco indicate that young heroin addicts often switch from pharmaceutical opioids to heroin, driven by the economics of drug supply. To address opioid use disorders, primary care has recognized MAT as critical, with new innovative models such as multi-level care and stakeholder engagement. Nevertheless, barriers such as stigma and lack of expertise pose challenges, highlighting the urgent need for refined strategies and models tailored to different primary care settings.
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