美国的令人惊叹的阿片类药物流行病

发生了什么

Opioids encompass a range of drugs that affect the pain and reward centers of the brain. Some of these drugs are made from plants, while others are synthetic.

当适当地管理时，阿片类药物羟考酮,fentanyl, andmorphinecan be used safely. But because of how these drugs affect the pain and pleasure receptors in our brain, it's possible to become dependent on them. Often the more you use them, the more you need them, and people can begin misusing the drugs as a result.

阿片类药物滥用是一个严重的公共卫生问题，即居住91.Americans every day. The number ofdrug overdose deaths与阿片类药物有关，自1999年以来在2000年代初飙升 - 没有流行失去蒸汽的迹象。

它也很高。疫情的价格在2013年达到了估计的785亿美元，但没有任何迷失的生命。根据统计新闻的投影，除非事情迅速抑制阿片类药物滥用的兴起，尽可能多的东西half a million peoplecould be killed by these drugs in the next decade.

Usingprescription drugs当他们没有被规定的时候是人们滥用阿片类药物的最常见方式之一，但近年来叫芬太尼的阿片类药物和其他类似药物的非法版本涌入市场已经增加了更加致命的。没有适当的管理或医疗监督，用户可能会冒险过度。随着预期的进一步削减预计医疗补助和经济实惠的护理法案，预计更多人将失去健康保险，并获得医疗护理 - 驾驶有些人寻求非法版本的药物，并加剧已经暴躁的情况。

Who Is Being Affected?

Not everyone who uses opioids滥用them or becomes dependent. When properly dosed and under medical supervision, prescription painkillers can be administered safely. It's when usage isn't monitored or when the drugs have been illicitly manufactured that people can developOpioid Use Disorder(OUD).

OUD looks different in different people. For some, it could simply mean craving opioids or taking more than intended, but for others, OUD results in closing off the world or letting your life fall apart because of your opioid use. If you don't have a medical professional helping you keep dosage under control or ensure the opioid you're using is safe, you run the risk of overdosing.

And this happens far too often.Drug overdosesare currently the leading cause of death in people under 50 in the United States, and六合一drug overdoses involve opioids. While this problem is widespread throughout the country, certain areas are more prone to opioid overdoses than others. The Rust Belt, Appalachia, and New England see higher rates of drug overdoses than the Plains, for example.

Young people appear to be disproportionately impacted by the epidemic. According to a2016年报告通过滥用药物和精神卫生服务管理，估计在过去一年中估计为万博手机客户端250万名年轻人滥用阿片类药物 - 任何年龄组的最高人。

What's perhaps most concerning among public health professionals is the number of teenagers involved. Nearly 900,000 adolescents aged 12 to 17 misused opioids in 2016. And while this is down from nearlyone millionin 2015, the number is still alarming, especially considering that most adolescents who misuse these drugsget them for free来自朋友或亲戚。

虽然年轻人不成比例地滥用阿片类药物，但老年人没有免疫。50岁的美国人在2016年滥用580万美国人滥用该类毒品，从2015年的大约170万增加。

Gender also appears to play a role. Currently, men are more likely to die due to an overdose of prescription painkillers, but that seems to be changing. Between 1999 and 2010, the number of women who died from prescription painkillers increased400 percent,而相比增加了237%deaths among men. Women are also more likely than men to be prescribed and use opioids for pain, making them a particularly vulnerable group when it comes to this epidemic. The overwhelming majority of people who take opioids—even illicit versions like heroin—do so because they are in pain due to things like cancer or a severe injury.

How We Got Here: A Short History

Prior to the 1980s, medical personnel was trained to give as few opioids as possible for pain because of fears of dependence. As a result, people with chronic pain were seriously undertreated. Throughout the 1980s, a series of articles were published pushing back at the notion that pain medications would result in dependence and encouraged doctors, instead, to reconsider their practice of avoiding long-term use of opioids to treat chronic pain.

The pendulum swung. With the encouragement of pharmaceutical companies, moredoctors began prescribing opioidsfor their patients, and America saw a huge spike in the number of unintentional overdose deaths from prescription painkillers. In the late 1990s, alarms went off, and the pendulum began to swing back the other way. Doctors once again scaled back prescriptions out of caution. In 2006, doctors wrote 72.4 opioid prescriptions for every 100 people in the United States. Ten years later that number fell to 66.5 per 100 people in 2016.

随着有效医疗处方的速度下降，非法和未经前置的阿片类药物的速度上升。当规定的阿片类药物耗尽或变得太贵时，一些患者转向海洛因作为更便宜的替代品。2010年，官员开始在海洛因过度注册尖峰，几年后由非法制造的芬太尼（IMF）过量。随着一个问题似乎被控制，另一个急于将其位置赶到一个名副其实的Whack-a-mole游戏。

人口统计学也转移了。来自阿片类药物的过量，用于主要影响30多岁和40多岁的白人，但迹象指向这些人口统计数据的转变，因为年轻人开始试验和滥用处方和非法止痛药。

我们如何解决它：公共卫生视角

Like many public health issues, there's no easy solution to the opioid epidemic. Combating the misuse of these drugs will take a multi-disciplinary approach that includes everyone from single individuals to massive government entities.

提供者和患者教育

An integral part of scaling back misuse of prescription painkillers will have to include educating patients taking these drugs on the importance of proper management and medical supervision, and the risks of dependence and overdose. Patients should also receive further counseling on how to correctly safeguard their prescriptions to avoid pills being misused by friends or family—especially teenagers.

Furthermore, the majority of people who use opioids say they do so because it helps them manage chronic pain. Depending on the intensity of the pain, the discomfort could potentially be managed with over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen, or non-medication therapies like physical therapy or hypnotherapy. Some argue that teaching doctors and patients about possible alternative pain management strategies could help reduce the number of opioids being prescribed by exhausting all non-opioid options first and leaving prescription painkillers as a last resort.

Increased Monitoring

其他全身问题可能成为意外超越的风险因素，例如多个医生写脚本或填充阿片类药物处方的多个药店。通过将标签保持在规定的内容上，它可以减少滥用处方止痛药的风险。Some states已经开始实施此类监视程序以取得大量成功，但数据和报告功能可能因状态而异。

然而,这不仅仅是关于处方。怒江mber of overdose deaths due to illicit opioids like heroin hasskyrocketed在过去的几年里。更多关于这些药物的数据，包括谁在内使用它们以及他们正在分发的地方，可以帮助官员更好地了解如何以及在哪里实现资源。

Treatment

It’s not enough to cut off the supply of opioids. You also need to find help for people who have already become dependent. Ironically, one of the most effective ways to overcome an opioid use disorder is to use less harmful opioid medications as part of a process known as Medication Assisted Treatment (MAT). Three such medications have been approved by the Food and Drug Administration to treat opioid dependence: methadone, buprenorphine, and extended-release naltrexone.

虽然这些药物的有效性可以vary, studies have shown them to reduce the physiological reliance on opioids and help those in active treatment overcome dependence. MAT, however, shouldn't be the only course of treatment. Because dependence can have both physiological and cognitive components, treatment programs see far more success if they address all aspects of dependence.

Treating substance use issues isn't just life-saving, it's also a good financial investment. It's estimated that for every $1 spent on substance use treatment in the United States, we could save between4美元和7美元in crime-related costs.

Harm Mitigation

Even with all of the above strategies in place, these things will take time, and there will inevitably be individuals who continue to misuse opioids despite the best efforts of the medical and public health communities. A small, but important, tactic could be to provide families and friends of users with rescue kits in the event of an overdose to reduce the risk of death.

Where We Go From Here

In October of 2017, President Donald Trump asked the U.S. Department of Health and Human Services to acknowledge the issue by declaring the opioid epidemic apublic health emergency。The White House's opioids commission issued一份报告在概述关于从这里到达的关键建议后不久，包括白宫管理和国会颁布的计划和政策变更的建议。

Other government entities have already put forward their intentions of how they can combat the epidemic. For its part, the FDA outlined anaction planfrom a regulatory standpoint. The seven-point plan includes forming an advisory committee, adding warning labels on prescription opioids, and requiring pharmaceutical companies to research the long-term impact of using opioids.

The Centers for Disease Control and Prevention (CDC) also issued指导方针for physicians before, during, and after writing an opioid prescription. In them, the agency encourages doctors to pursue other types of treatments first, such as physical therapy and steroid injections, and use opioids only as a last-resort treatment for pain.

Innovative solutions at the state level have shown early promise as well. Massachusetts, for example, has expanded access to treatment medication through a nurse manager model that allows doctors to treat more patients than if they were the primary managers. Another program in Maryland leverages social workers as support for medical teams to reach more people and reduce treatment waitlists.

These programs will be increasingly important as changes are proposed and made to the Affordable Care Act and government assistance programs like Medicaid. Because medical supervision is critical to helping patients manage their pain safely and effectively, access to affordable healthcare will be an important component of any and all efforts to combat the epidemic.