College of Public Health, East Tennessee State University, Johnson City, TN, USA.
Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA.
Curr HIV/AIDS Rep. 2018 Oct;15(5):359-370. doi: 10.1007/s11904-018-0409-9.
This review aims to (1) conceptualize the complexity of the opioid use disorder epidemic using a conceptual model grounded in the disease continuum and corresponding levels of prevention and (2) summarize a select set of interventions for the prevention and treatment of opioid use disorder.
Epidemiologic data indicate non-medical prescription and illicit opioid use have reached unprecedented levels, fueling an opioid use disorder epidemic in the USA. A problem of this magnitude is rooted in multiple supply- and demand-side drivers, the combined effect of which outweighs current prevention and treatment efforts. Multiple primary, secondary, and tertiary prevention interventions, both evidence-informed and evidence-based, are available to address each point along the disease continuum-non-use, initiation, dependence, addiction, and death. If interventions grounded in the best available evidence are disseminated and implemented across the disease continuum in a coordinated and collaborative manner, public health systems could be increasingly effective in responding to the epidemic.
综述目的:本综述旨在:(1) 利用基于疾病连续谱和相应预防水平的概念模型来理解阿片类药物使用障碍流行的复杂性;(2) 总结预防和治疗阿片类药物使用障碍的一系列干预措施。
最近的发现:流行病学数据表明,非医疗处方和非法阿片类药物的使用已达到前所未有的水平,在美国引发了阿片类药物使用障碍的流行。如此规模的问题源于多个供应方和需求方驱动因素,其综合影响超过了当前的预防和治疗工作。有多种初级、二级和三级预防干预措施,既有证据支持,也有证据基础,可用于解决疾病连续谱中的每一个环节——非使用、开始使用、依赖、成瘾和死亡。如果以最佳现有证据为基础的干预措施在疾病连续谱中以协调和协作的方式传播和实施,公共卫生系统可能会在应对这一流行疾病方面更加有效。