Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado.
Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina.
Curr Opin Anaesthesiol. 2020 Jun;33(3):327-334. doi: 10.1097/ACO.0000000000000865.
Over the last 3 years and for the first time in 60 years, life expectancy in the United States has declined across all racial groups primarily because of drug overdoses, alcohol abuse, and suicide. A public health response to the opioid crisis must expand its focus to more broadly include children, adolescents, and young adults while increasing efforts toward preventing new cases of opioid addiction, early identification of individuals with opioid-abuse disorder, and ensuring access to effective opioid addiction treatment, while simultaneously continuing to safely meet the needs of patients experiencing pain.
Although a multimodal approach to pain management is fundamental in current practice, opioids remain an essential building block in the management of acute and chronic pain and have been for over 5000 years as they work. Left over, unconsumed opioids that were appropriately prescribed for pain have become the gateway for the development of opioid use disorder, particularly in the vulnerable adolescents and young adult patient populations. How to reduce the amount of opioids dispensed, improve methods of disposal in an environmentally safe way, and proactively make naloxone, particularly nasal spray, readily available to patients (and their families) receiving prescription opioids or who are at risk of opioid use disorder are highlighted in this review.
We describe the historical use of opioids and the scope of the current opioid crisis, review the differences between dependence and addiction, and the private and public sectors response to pain management and highlight the issue of adolescent vulnerability. We conclude with a proposal for future directions that address both public and patient health needs.
在过去 3 年中，美国的预期寿命在所有种族群体中首次出现了 60 年来的下降，这主要是由于药物过量、酗酒和自杀。应对阿片类药物危机的公共卫生措施必须扩大其重点，更广泛地包括儿童、青少年和年轻人，同时加大力度预防新的阿片类药物成瘾病例，及早发现有阿片类药物滥用障碍的个人，并确保获得有效的阿片类药物成瘾治疗，同时继续安全地满足正在经历疼痛的患者的需求。
尽管多模式疼痛管理方法是当前实践的基础，但阿片类药物仍然是急性和慢性疼痛管理的重要组成部分，而且已经使用了 5000 多年，因为它们有效。剩余的、未消耗的、用于治疗疼痛的阿片类药物已成为阿片类药物使用障碍发展的途径，尤其是在易受伤害的青少年和年轻成年患者群体中。本综述强调了如何减少开出的阿片类药物的数量，以更安全的方式处理阿片类药物，并积极向接受处方阿片类药物或有阿片类药物使用障碍风险的患者（及其家属）提供纳洛酮，特别是鼻喷雾剂。
我们描述了阿片类药物的历史用途和当前阿片类药物危机的范围，回顾了依赖和成瘾之间的区别，以及私人和公共部门对疼痛管理的反应，并强调了青少年易受伤害的问题。最后，我们提出了未来的方向，以满足公众和患者的健康需求。
