Department of Medicine, Division of General Internal Medicine, Geriatrics, and Palliative Care, University of Virginia, Charlottesville, Virginia 22908-0466, USA.
J Palliat Med. 2013 Mar;16(3):237-42. doi: 10.1089/jpm.2012.0263. Epub 2013 Jan 5.
Although inadequate treatment of pain is a problem for hospice patients, increases in the medical use of opioids have been accompanied by increasing levels of abuse and diversion in the community. Balancing pain relief with concerns about abuse and diversion is a difficult issue for hospices.
The aim of this study was to determine policies and practices in Virginia hospices regarding substance abuse and diversion in patients and their families.
A survey was conducted of Virginia hospices about policies, perceptions, and training regarding substance abuse and diversion.
Twenty-three of 63 hospice agencies responded (36.5%). Less than half (43.8%) required mandatory substance abuse training. Only 43.5% had policies regarding screening for substance abuse in patients; 30.4% had a policy regarding screening for substance abuse in family members. Policies regarding screening for diversion in patients (21.7%), and families (17.4%) were rare. Policies regarding opioid use in patients with a history of substance abuse or diversion were uncommon (33.3%, 30.4%, respectively); 30.4% had policies regarding use of opioids in patients whose family members had a history of diversion or abuse. Thirty-eight percent of hospices agreed that substance abuse and diversion was a problem for their agency, and these agencies were more likely to have written policies or mandatory training.
Most Virginia hospices lack mandatory training and policies regarding substance abuse and diversion in patients and family members. More than one-third felt that abuse and diversion were problems in their agencies. A national conversation regarding policies toward substance abuse and diversion in hospice agencies is needed.
尽管姑息治疗患者的疼痛治疗不足是一个问题，但社区中阿片类药物的医疗使用增加伴随着滥用和转用的增加。平衡疼痛缓解与对滥用和转用的担忧是姑息治疗机构面临的一个难题。
本研究旨在确定弗吉尼亚州姑息治疗机构在患者及其家属的药物滥用和转用方面的政策和做法。
对弗吉尼亚州的姑息治疗机构进行了一项关于药物滥用和转用的政策、看法和培训的调查。
在 63 家姑息治疗机构中有 23 家（36.5%）做出了回应。不到一半（43.8%）要求强制进行药物滥用培训。只有 43.5%的机构制定了针对患者药物滥用筛查的政策；30.4%制定了针对家庭成员药物滥用筛查的政策。针对患者（21.7%）和家属（17.4%）转用筛查的政策很少。针对有药物滥用或转用史的患者（33.3%，30.4%）以及有转用或滥用史的家庭成员（17.4%）的阿片类药物使用政策也不常见。30.4%的机构制定了针对有药物滥用或转用史的患者使用阿片类药物的政策；30.4%的机构制定了针对有转用或滥用史的家庭成员的阿片类药物使用政策。38%的姑息治疗机构认为药物滥用和转用是其机构的一个问题，这些机构更有可能制定书面政策或强制培训。
大多数弗吉尼亚州姑息治疗机构缺乏针对患者和家庭成员药物滥用和转用的强制培训和政策。超过三分之一的机构认为滥用和转用是其机构的问题。姑息治疗机构在药物滥用和转用上的政策需要进行全国性的讨论。
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