Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts 02454; email:
Annu Rev Public Health. 2015 Mar 18;36:559-74. doi: 10.1146/annurev-publhealth-031914-122957. Epub 2015 Jan 12.
Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is required to effectively reduce opioid-related morbidity and mortality. We describe the scope of this public health crisis, its historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality, and we provide a framework for interventions to address the epidemic of opioid addiction.
公共卫生当局越来越震惊地描述了与阿片类止痛药(OPR)使用相关的发病率和死亡率的空前增加。解决阿片类药物危机的努力主要集中在减少非医疗 OPR 的使用上。然而,人们往往忽略了预防和治疗阿片类药物成瘾的必要性,这种成瘾既发生在医疗用 OPR 使用者中,也发生在非医疗用 OPR 使用者中。OPR 的过度处方导致阿片类药物成瘾的患病率急剧上升,而阿片类药物成瘾反过来又与过量死亡和海洛因使用的增加有关。需要采用多方面的公共卫生方法,利用初级、二级和三级阿片类药物成瘾预防策略,才能有效地降低与阿片类药物相关的发病率和死亡率。我们描述了这一公共卫生危机的范围、其历史背景、促成因素以及表明成瘾在加剧发病率和死亡率方面的作用的证据,并提供了一个解决阿片类药物成瘾流行的干预框架。
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