Department of Anesthesiology, Yale University, TMP3 333, Cedar Street, New Haven, CT, 06520, USA.
Department of Internal Medicine, NYU Winthrop Hospital, 259 First Street, Mineola, NY, 11501, USA.
Curr Pain Headache Rep. 2018 Feb 23;22(3):16. doi: 10.1007/s11916-018-0670-z.
The opioid crisis most likely is the most profound public health crisis our nation has faced. In 2015 alone, 52,000 people died of drug overdoses, with over 30,000 of those people dying from opioid drugs. A recent community forum led by the Cleveland Clinic contrasted this yearly death rate with the loss of 58,000 American lives in 4 years of the Vietnam War. The present review describes the origins of this opioid epidemic and provides context for our present circumstances.
Alarmingly, the overwhelming majority of opioid abusers begin their addiction with prescription medications, primarily for chronic pain. Chronic postoperative pain, which occurs in 10-50% of surgical patients, is a major concern in many types of surgery. Nationwide, the medical community has made it a priority to ensure that postsurgical analgesia is sufficient to control pain without increasing non-medically appropriate opioid use. The opioid epidemic remains a significant pressing issue and will not resolve easily. Numerous factors, including the inappropriate prescription of opioids, lack of understanding of the potential adverse effects of long-term therapy, opioid misuse, abuse, and dependence, have contributed to the current crisis.
阿片类药物危机很可能是我国面临的最严重的公共卫生危机。仅 2015 年一年,就有 5.2 万人死于药物过量,其中超过 3 万人死于阿片类药物。克利夫兰诊所(Cleveland Clinic)最近举办的一次社区论坛将这一年的死亡率与越南战争 4 年中 5.8 万美国人的死亡人数进行了对比。本综述描述了阿片类药物流行的起源,并为我们目前的情况提供了背景。
令人震惊的是,绝大多数阿片类药物滥用者都是从处方药物开始上瘾的,主要是用于治疗慢性疼痛。在 10-50%的手术患者中都会出现慢性术后疼痛,这是许多类型手术的主要关注点。在全国范围内,医学界已将确保术后镇痛足以控制疼痛而不增加非医学上适当的阿片类药物使用作为优先事项。阿片类药物危机仍然是一个重大紧迫的问题,不会轻易解决。许多因素,包括阿片类药物的不当处方、对长期治疗潜在不良反应的认识不足、阿片类药物的误用、滥用和依赖,都导致了目前的危机。