Laurentian University, Sudbury, ON, Canada.
Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada.
Subst Abuse Treat Prev Policy. 2017 Nov 2;12(1):45. doi: 10.1186/s13011-017-0130-5.
Addressing opioid use disorder has become a priority in Ontario, Canada, because of its high economic, social and health burden. There continues to be stigma and criticism relating to opioid use disorder and treatment options. The result has been unsystematic, partial, reactive policies and programs developed based on divergent points of view. The aim of this manuscript is to describe how past and present understandings, narratives, ideologies and discourse of opioid use, have impacted policies over the course of the growing opioid crisis.
Assessing the impact of policy is complex. It involves consideration of conceptual issues of what impacts policy change. In this manuscript we argue that the development of polices and initiatives regarding opioids, opioid use disorder and opioid agonist treatment in the last decade, have been more strongly associated with the evolution of ideas, narratives and discourses rather than research relating to opioids. We formulate our argument using a framework by Sumner, Crichton, Theobald, Zulu, and Parkhurs. We use examples from the Canadian context to outline our argument such as: the anti- drug legislation from the Canadian Federal Conservative government in 2007; the removal of OxyContin™ from the drug formulary in 2012; the rapid expansion of opioid agonist treatment beginning in the early 2000s, the unilateral decision made regarding fee cuts for physicians providing opioid agonist treatment in 2015; and the most recent implementation of a narcotics monitoring system, which are all closely linked with the shifts in public opinion and discourse at the time of which these policies and programs are implemented.
We conclude with recommendations to consider a multifactorial response using evidence and stakeholder engagement to address the opioid crisis, rather than a reactive policy approach. We suggest that researchers have an important role in shaping future policy by reframing ideas through knowledge translation, formation of values, creation of new knowledge and adding to the quality of public discourse and debate.
由于阿片类药物使用障碍给加拿大安大略省带来了高昂的经济、社会和健康负担，因此解决这一问题已成为当务之急。针对阿片类药物使用障碍和治疗选择，人们的看法仍存在污名化和批评。结果是基于不同观点制定了非系统性、片面的、被动的政策和方案。本文旨在描述过去和现在对阿片类药物使用的理解、叙述、意识形态和话语如何影响不断发展的阿片类药物危机期间的政策。
评估政策的影响很复杂。它涉及到考虑影响政策变化的概念问题。在本文中，我们认为，在过去十年中，关于阿片类药物、阿片类药物使用障碍和阿片类激动剂治疗的政策和倡议的制定，更多地与思想、叙述和话语的演变相关，而不是与阿片类药物相关的研究。我们使用 Sumner、Crichton、Theobald、Zulu 和 Parkhurs 的框架来提出我们的观点。我们使用加拿大的例子来阐述我们的观点，例如：2007 年加拿大联邦保守党政府的反毒品立法；2012 年将奥施康定从药物处方中删除；2000 年代初开始迅速扩大阿片类激动剂治疗，2015 年单方面决定削减为提供阿片类激动剂治疗的医生的费用；以及最近实施的麻醉品监测系统，这些都与当时的公众舆论和话语转变密切相关政策和计划的实施。
我们的结论是，建议考虑采用多因素应对措施，利用证据和利益相关者的参与来解决阿片类药物危机，而不是采取被动的政策方法。我们建议研究人员通过知识转化、价值观形成、新知识创造以及为公共话语和辩论增添质量，在塑造未来政策方面发挥重要作用。
