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在一个存在阿片类药物依赖问题的偏远原住民社区中采取的全社区健康促进措施:在原住民康复计划背景下评估门诊丁丙诺啡 - 纳洛酮替代疗法。

Community-wide measures of wellness in a remote First Nations community experiencing opioid dependence: evaluating outpatient buprenorphine-naloxone substitution therapy in the context of a First Nations healing program.

作者信息

Kanate Dinah, Folk David, Cirone Sharon, Gordon Janet, Kirlew Mike, Veale Terri, Bocking Natalie, Rea Sara, Kelly Len

出版信息

Can Fam Physician. 2015 Feb;61(2):160-5.

Abstract

OBJECTIVE

To document the development of unique opioid-dependence treatment in remote communities that combines First Nations healing strategies and substitution therapy with buprenorphine-naloxone.

DESIGN

Quantitative measurements of community wellness and response to community-based opioid-dependence treatment.

SETTING

Remote First Nations community in northwestern Ontario.

PARTICIPANTS

A total of 140 self-referred opioid-dependent community members.

INTERVENTION

Community-developed program of First Nations healing, addiction treatment, and substitution therapy.

MAIN OUTCOME MEASURES

Community-wide measures of wellness: number of criminal charges, addiction-related medical evacuations, child protection agency cases, school attendance, and attendance at community events.

RESULTS

The age-adjusted adult rate of opioid-dependence treatment was 41%. One year after the development of the in-community healing and substitution therapy program for opioid dependence, police criminal charges had fallen by 61.1%, child protection cases had fallen by 58.3%, school attendance had increased by 33.3%, and seasonal influenza immunizations had dramatically gone up by 350.0%. Attendance at community events is now robust, and sales at the local general store have gone up almost 20%.

CONCLUSION

Community-wide wellness measures have undergone dramatic public health changes since the development of a First Nations healing program involving opioid substitution therapy with buprenorphine-naloxone. Funding for such programs is ad hoc and temporary, and this threatens the survival of the described program and other such programs developing in this region, which has been strongly affected by an opioid-dependence epidemic.

摘要

目的

记录在偏远社区开展的独特阿片类药物依赖治疗的发展情况,该治疗将原住民康复策略与丁丙诺啡 - 纳洛酮替代疗法相结合。

设计

对社区健康状况以及基于社区的阿片类药物依赖治疗反应进行定量测量。

地点

安大略省西北部的偏远原住民社区。

参与者

总共140名自我转诊的阿片类药物依赖社区成员。

干预措施

社区开发的原住民康复、成瘾治疗和替代疗法项目。

主要观察指标

全社区健康指标:刑事指控数量、与成瘾相关的医疗后送次数、儿童保护机构案件数量、学校出勤率以及社区活动出勤率。

结果

经年龄调整后的阿片类药物依赖治疗成人比率为41%。在为阿片类药物依赖制定社区内康复和替代疗法项目一年后,警方刑事指控下降了61.1%,儿童保护案件下降了58.3%,学校出勤率提高了33.3%,季节性流感疫苗接种率大幅上升了350.0%。现在社区活动的参与率很高,当地杂货店的销售额增长了近20%。

结论

自从开展涉及丁丙诺啡 - 纳洛酮阿片类药物替代疗法的原住民康复项目以来,全社区健康指标发生了巨大的公共卫生变化。此类项目的资金是临时且临时安排的,这威胁到了所述项目以及该地区正在开展的其他此类项目的生存,该地区受到阿片类药物依赖流行的严重影响。

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本文引用的文献

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