Dans P E, Matricciani R M, Otter S E, Reuland D S
Office of Medical Practice Evaluation, Johns Hopkins Medical Institutions, Baltimore, Md.
JAMA. 1990 Jun 20;263(23):3173-6.
Increasing reports of management problems involving intravenous drug abuse patients prompted our study. From 1983 to 1988, the recorded inpatient prevalence of diagnoses consistent with drug abuse/dependence, other than alcohol or nicotine, rose hospitalwide from 0.6% to 3.5%. Disruptive behavior was documented in the records of 38 of 71 active cocaine or heroin users admitted during 1988 vs 12 of 64 matched control subjects. Care and teaching focused principally on secondary complications of intravenous drug use. Study recommendations included (1) establishment of a comprehensive substance abuse treatment education, and research program with a dedicated inpatient unit; (2) use of an explicit social contract between patients and care givers; and (3) staff education about legal limits in managing disruptive patients and searching for illegal substances. Primary and secondary prevention, including combating societal enabling of substance abuse, should be the institution's long-term goals.
涉及静脉药物滥用患者管理问题的报告日益增多，促使我们开展此项研究。1983年至1988年期间，全院范围内记录在案的除酒精或尼古丁以外符合药物滥用/依赖诊断的住院患病率从0.6%升至3.5%。1988年收治的71名活跃可卡因或海洛因使用者中，有38人的记录显示存在破坏性行为，而64名匹配的对照受试者中有12人有此类行为。护理和教学主要集中在静脉药物使用的次要并发症上。研究建议包括：(1)建立一个综合的药物滥用治疗、教育和研究项目，并设有专门的住院单元；(2)患者与护理人员之间签订明确的社会契约；(3)对工作人员进行关于管理破坏性行为患者和搜查非法物质的法律界限的教育。包括打击社会对药物滥用的纵容在内的一级和二级预防应成为该机构的长期目标。
