a Department of Psychiatry , Columbia University , New York , USA.
b New York State Psychiatric Institute , New York , USA.
Am J Drug Alcohol Abuse. 2019;45(1):1-10. doi: 10.1080/00952990.2018.1546862. Epub 2019 Jan 24.
Amid worsening opioid overdose death rates, the nation continues to face a persistent addiction treatment gap limiting access to quality care for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and extended-release naltrexone) have high quality evidence demonstrating reductions in drug use and overdose events, but most individuals with OUD do not receive them. The development of a unified public health framework, such as a Cascade of Care, could improve system level practice and treatment outcomes. In response to feedback from many stakeholders over the past year, we have expanded upon the OUD treatment cascade, first published in 2017, with additional attention to prevention stages and both individual-level and population-based services to better inform efforts at the state and federal level. The proposed cascade framework has attracted considerable interest from federal agencies including the Centers for Disease Control and Prevention (CDC) and National Institute on Drug Abuse (NIDA) along with policy-makers nationwide. We have reviewed recent literature and evidence-based interventions related to prevention, identification, and treatment of individuals with OUD and modeled updated figures from the 2016 National Survey on Drug Use and Health. Many currently employed interventions (prescriber guidelines, prescription monitoring programs, naloxone rescue) address prevention of OUD or downstream complications but not treatment of the underlying disorder itself. An OUD Cascade of Care framework could help structure local and national efforts to combat the opioid epidemic by identifying key targets, interventions, and quality indicators across populations and settings to achieve these ends. Improved data collection and reporting methodology will be imperative.
在阿片类药物过量死亡率不断恶化的情况下，美国仍面临着持续存在的成瘾治疗缺口，限制了阿片类药物使用障碍（OUD）获得优质护理的机会。三种获得美国食品和药物管理局（FDA）批准的药物（美沙酮、丁丙诺啡和纳曲酮延长释放剂）具有高质量的证据，证明可以减少药物使用和过量事件，但大多数 OUD 患者无法获得这些药物。制定一个统一的公共卫生框架，如护理级联，可能会改善系统层面的实践和治疗效果。针对过去一年来许多利益相关者的反馈，我们在 2017 年首次发表的 OUD 治疗级联的基础上进行了扩展，增加了对预防阶段以及个体和基于人群的服务的关注，以便更好地为州和联邦各级的努力提供信息。拟议的级联框架引起了包括疾病控制与预防中心（CDC）和国家药物滥用研究所（NIDA）在内的联邦机构以及全国政策制定者的极大兴趣。我们审查了最近与预防、识别和治疗 OUD 个体相关的文献和基于证据的干预措施，并对 2016 年全国药物使用和健康调查的更新数据进行了建模。许多目前采用的干预措施（处方指南、处方监测计划、纳洛酮解毒剂）都针对预防 OUD 或下游并发症，但不针对潜在疾病本身进行治疗。OUD 护理级联框架可以帮助构建地方和国家的努力，通过确定关键目标、干预措施和质量指标，在不同人群和环境中对抗阿片类药物流行，实现这些目标。改进数据收集和报告方法将是至关重要的。
