Winetsky Daniel, Weinrieb Robert M, Perrone Jeanmarie
Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Hosp Med. 2018 Jan;13(1):62-64. doi: 10.12788/jhm.2861. Epub 2017 Oct 18.
The prevalence of opioid use disorders (OUDs) is rising across the United States. Patients with OUDs are often hospitalized for medical conditions other than addiction, such as infection, injury, or pregnancy. These hospital admissions provide an opportunity for healthcare providers to initiate opioid agonist therapy with methadone or buprenorphine. Randomized trials have demonstrated the superior effectiveness of this treatment strategy, but its adoption by hospital providers has been slow. A number of barriers have impeded its implementation, including misperceptions about the regulation of opioid prescribing, limited resources for the transition to community- based treatment, and a lack of familiarity among clinicians about the appropriate initiation and dose adjustment of these opioid agonists for maintenance therapy. We discuss changes in policy and practice to expand opportunities to engage patients with OUDs in opioid agonist treatment during their inpatient hospitalizations.
在美国，阿片类物质使用障碍（OUDs）的患病率正在上升。患有OUDs的患者经常因成瘾以外的医疗状况住院，如感染、受伤或怀孕。这些住院治疗为医疗服务提供者提供了一个机会，可启动美沙酮或丁丙诺啡的阿片类激动剂治疗。随机试验已证明这种治疗策略具有更高的有效性，但医院提供者对其采用速度一直较慢。一些障碍阻碍了其实施，包括对阿片类药物处方监管的误解、向社区治疗过渡的资源有限，以及临床医生对这些阿片类激动剂用于维持治疗的适当起始和剂量调整缺乏了解。我们讨论了政策和实践方面的变化，以扩大在住院期间让患有OUDs的患者接受阿片类激动剂治疗的机会。
