University of Tennessee Health Science Center College of Pharmacy, Memphis, TN.
Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN.
Am J Health Syst Pharm. 2019 Mar 19;76(7):424-435. doi: 10.1093/ajhp/zxy089.
The purpose of this review is to (1) provide information concerning the opioid crisis including origins, trends, and some important related laws/policies; and (2) summarize the current involvement and impact of pharmacists in helping to address the crisis, as well as examine practices in other healthcare disciplines from which pharmacists might derive guidance and strategies.
Contributors to the opioid crisis included campaigns to treat pain as a fifth vital sign and to use opioids in treatment of non-cancer-related pain, as well as aggressive marketing of opioid analgesics by pharmaceutical companies. To address the crisis, numerous strategies have been implemented at the policy/legislative, health-system, and patient levels, such as prescription drug monitoring programs (PDMPs), increased regulation of pain clinics, and expanded use of naloxone. Pharmacists have a critical role to play in interventions to address opioid misuse and reduce harm resulting from misuse. Such interventions include patient screening and risk stratification, patient and community education and outreach concerning appropriate pain management, medication reviews/medication therapy management, education on safe storage and disposal, distribution of naloxone/opioid rescue kits and training on their proper use, and referral of patients to addiction treatment, among other strategies.
Pharmacists have multiple, complex roles in addressing the opioid crisis. Outcomes of several studies provide substantial evidence that pharmacists can make an impact through appropriate pain management, use of PDMPs, opioid overdose prevention training, and medication reviews and counseling, among other interventions.
本文旨在（1）提供有关阿片类药物危机的信息，包括其起源、趋势和一些重要的相关法律/政策；（2）总结药剂师目前在帮助解决危机方面的参与情况和影响，并考察其他医疗保健学科的实践经验，以从中获取指导和策略。
阿片类药物危机的促成因素包括将疼痛作为第五大生命体征进行治疗的运动，以及将阿片类药物用于治疗非癌症相关疼痛的做法，此外制药公司还积极推销阿片类镇痛药。为了解决这一危机，已在政策/立法、医疗系统和患者层面实施了多项策略，例如处方药物监测计划（PDMP）、加强对疼痛诊所的监管，以及扩大纳洛酮的使用。药剂师在解决阿片类药物滥用问题和减少滥用造成的危害方面可以发挥关键作用。此类干预措施包括对患者进行筛查和风险分层、对患者和社区进行有关适当疼痛管理的教育和外展、药物评估/药物治疗管理、有关安全储存和处置的教育、分发纳洛酮/阿片类药物急救包以及对其正确使用进行培训，以及将患者转介至戒毒治疗等。
药剂师在解决阿片类药物危机方面具有多种复杂的角色。几项研究的结果提供了充分的证据表明，药剂师可以通过适当的疼痛管理、使用 PDMP、预防阿片类药物过量的培训以及药物评估和咨询等干预措施产生影响。
