Smith David E
a Principal, David E. Smith, MD & Associates , San Francisco , CA , USA.
b Strategic Advisor and Chair, Addiction Medicine , Alta Mira Recovery Centers , Sausalito , CA , USA.
J Psychoactive Drugs. 2017 Apr-Jun;49(2):95-101. doi: 10.1080/02791072.2017.1295334. Epub 2017 Mar 15.
The medicalization of the current opioid epidemic in the era of health care reform and parity, and its possible dismantling, poses many challenges. Between 2002 and 2013, drug overdose rates quadrupled. Parallel to an increase in prescription opioid overdose, heroin overdose deaths are increasing as patients shift to cheaper and more accessible heroin from the prescription opioids which physicians are prescribing less often due to increasing regulatory restrictions, as well as enhanced education and awareness. In many areas, the leading cause of death for young adults is drug overdose. Unlike previous heroin use in the U.S., the nexus of spread is coming primarily out of the medical system, as the line between legal and illicit narcotics has become blurred. The economic and social benefits of bringing the previously excluded addicted population into the mainstream health care system will be substantial and will bring changes in three major areas: mental health and substance abuse services in health plans; parity protection in all insurance plans; substance abuse and mental health services. Long-term implementation of these changes in a medically oriented system will require the development of many new systems and procedures.
在医疗保健改革与平权时代，当前阿片类药物流行的医学化及其可能的消解带来了诸多挑战。2002年至2013年间，药物过量使用率增长了四倍。与处方阿片类药物过量情况增加同时出现的是，海洛因过量致死人数也在上升，因为患者正从处方阿片类药物转向更便宜且更容易获取的海洛因，而由于监管限制日益严格以及教育和意识的提高，医生开具处方阿片类药物的频率在降低。在许多地区，年轻人的主要死因是药物过量。与美国以往的海洛因使用情况不同，传播的关联主要源自医疗系统，因为合法与非法麻醉品之间的界限已变得模糊。将先前被排除在外的成瘾人群纳入主流医疗保健系统所带来的经济和社会效益将是巨大的，并将在三个主要领域带来变化：健康计划中的心理健康和药物滥用服务；所有保险计划中的平权保护；药物滥用和心理健康服务。在以医学为导向的系统中长期实施这些变革将需要开发许多新的系统和程序。
