Weisberg Daniel F, Becker William C, Fiellin David A, Stannard Cathy
Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, United States.
VA Connecticut Healthcare System, West Haven, CT, United States; Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, United States.
Int J Drug Policy. 2014 Nov;25(6):1124-30. doi: 10.1016/j.drugpo.2014.07.009. Epub 2014 Jul 30.
In the United States, opioid analgesics have increasingly been prescribed in the treatment of chronic pain, and this trend has accompanied increasing rates of misuse and overdose. Lawmakers have responded with myriad policies to curb the growing epidemic of opioid misuse, and a global alarm has been sounded among countries wishing to avoid this path. In the United Kingdom, a similar trend of increasing opioid consumption, albeit at lower levels, has been observed without an increase in reported misuse or drug-related deaths. The comparison between these two countries in opioid prescribing and opioid overdose mortality underscores important features of prescribing, culture, and health systems that may be permissive or protective in the development of a public health crisis. As access to opioid medications increases around the world, it becomes vitally important to understand the forces impacting opioid use and misuse. Trends in benzodiazepine and methadone use in the UK as well as structural elements of the National Health Service may serve to buffer opioid-related harms in the face of increasing prescriptions. In addition, the availability and price of heroin, as well as the ease of access to opioid agonist treatment in the UK may limit the growth of the illicit market for prescription opioids. The comparison between the US and the UK in opioid consumption and overdose rates should serve as a call to action for UK physicians and policymakers. Basic, proactive steps in the form of surveillance - of overdoses, marketing practices, prescribers, and patients - and education programs may help avert a public health crisis as opioid prescriptions increase.
在美国，阿片类镇痛药越来越多地被用于治疗慢性疼痛，而这一趋势伴随着滥用和过量使用发生率的上升。立法者已出台众多政策来遏制日益严重的阿片类药物滥用流行，希望避免走上这条道路的国家也已敲响全球警钟。在英国，尽管阿片类药物消费增长趋势较为缓和，但也观察到类似趋势，且报告的滥用情况或与药物相关的死亡人数并未增加。这两个国家在阿片类药物处方和阿片类药物过量死亡率方面的比较凸显了处方、文化和卫生系统的重要特征，这些特征在公共卫生危机的发展中可能起到放任或保护作用。随着全球范围内阿片类药物的可及性增加，了解影响阿片类药物使用和滥用的因素变得至关重要。英国苯二氮䓬类药物和美沙酮的使用趋势以及国民医疗服务体系的结构要素，可能有助于在处方增加的情况下缓冲与阿片类药物相关的危害。此外，英国海洛因的可及性和价格，以及阿片类激动剂治疗的易获得性，可能会限制处方阿片类药物非法市场的增长。美国和英国在阿片类药物消费和过量率方面的比较应促使英国医生和政策制定者采取行动。以对过量用药、营销行为、开处方者和患者进行监测以及开展教育项目等形式采取的基本、积极措施，可能有助于在阿片类药物处方增加时避免公共卫生危机。
