Franklin Gary M
From the Departments of Occupational and Environmental Health Sciences, Neurology, and Health Services, University of Washington, Seattle.
Neurology. 2014 Sep 30;83(14):1277-84. doi: 10.1212/WNL.0000000000000839.
The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35-54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events.
患者安全小组委员会要求对美国迅速出现的与处方阿片类药物相关的发病率和死亡率这一公共卫生流行病的科学和政策问题进行审查。自20世纪90年代末政策改变以来，美国已有超过10万人直接或间接死于处方阿片类药物。在最高风险群体（35至54岁）中，这些死亡人数已超过枪支和机动车事故造成的死亡人数。虽然有证据表明阿片类药物能显著缓解短期疼痛，但没有实质性证据表明在不产生严重过量用药、依赖或成瘾风险的情况下，能长期维持疼痛缓解或改善功能。本文的目的是审查以下内容：（1）该流行病的关键起始原因；（2）阿片类药物用于慢性疼痛的安全性和有效性证据；（3）联邦和州的政策应对措施；（4）为执业神经科医生提供建议，以增加最有可能改善阿片类药物有效和安全使用并降低严重不良事件和过量用药事件可能性的最佳实践/通用预防措施的使用。
