Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Avenue Suite 710, Norfolk, VA 23507, USA.
Institute for Health Research, Kaiser Permanente Colorado, 2550 South Parker Road, Suite 200, Aurora, CO 80014, USA; Division of General Internal Medicine, Department of Medicine, University of Colorado, 12631 East 17th Avenue, Academic Office One, Campus Box B180, Aurora, CO 80045, USA.
Med Clin North Am. 2018 Jul;102(4):621-634. doi: 10.1016/j.mcna.2018.02.005.
Drawing from existing opioid prescribing guidelines, this article describes how medical providers can reduce the risk of overdose. Through primary prevention, providers can prevent initial exposure and associated risks by educating patients, using risk stratification, minimizing opioid dose and duration, and avoiding coprescribing with sedatives. Secondary prevention efforts include monitoring patients with urine toxicology and prescription monitoring programs, and screening for opioid use disorders. Tertiary prevention includes treating opioid use disorders and providing naloxone to prevent overdose death. Specific preventive strategies may be required for those with psychiatric disorders or substance use disorders, adolescents, the elderly, and pregnant women.
本文借鉴现有的阿片类药物处方指南，介绍了医疗服务提供者如何降低药物过量风险。通过初级预防，通过教育患者、进行风险分层、尽量减少阿片类药物剂量和持续时间、避免与镇静剂联合用药，医疗服务提供者可以预防初次接触和相关风险。二级预防措施包括对患者进行尿液毒物检测和处方监测项目监测，并筛查阿片类药物使用障碍。三级预防包括治疗阿片类药物使用障碍和提供纳洛酮以预防药物过量死亡。对于患有精神疾病或物质使用障碍、青少年、老年人和孕妇等特定人群，可能需要采取具体的预防策略。
