Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV.
Int J Drug Policy. 2020 Nov;85:102796. doi: 10.1016/j.drugpo.2020.102796. Epub 2020 Jun 1.
Non-fatal and fatal overdoses are traumatic events that have been increasing over the past 20 years and disproportionately impacting rural communities in the United States. The human suffering caused by the opioid epidemic is rarely described in the empirical literature. The purpose of this article is to 1) define individual- and community-level overdose-related compassion fatigue (OCF), 2) review measurement of compassion fatigue (CF) and interventions to reduce CF, 3) discuss strategies that may reduce OCF and 4) briefly discuss policy implications. OCF is distress resulting from knowledge of or exposure to overdose-related harms, which at the community-level may prohibit collaboration and adaptive agency to effectively respond. When OCF occurs at a community-level, it could have negative consequences by eroding support for evidence-based services and fueling stigma-driven policies that blame people who use drugs. Empathy underlies both OCF and vicarious resilience by allowing one to understand the suffering caused by overdose deaths and to witness the joy of addiction recovery. Using the risk environment framework, OCF at the micro- and macro-levels of the social environment, may increase rural communities' vulnerability to harm by emphasizing individual responsibility for reducing overdoses rather than community-level infrastructure and resource management. Additional research is needed to develop a measure of OCF and to confirm whether OCF is associated with increased stigma and decreased support for harm reduction in rural areas.
非致命性和致命性过量用药是创伤性事件，在过去 20 年中不断增加，并且不成比例地影响美国的农村社区。阿片类药物流行所造成的人类痛苦在经验文献中很少被描述。本文的目的是：1）定义与过量用药相关的同情疲劳（OCF）的个体和社区层面，2）回顾同情疲劳（CF）的测量和减少 CF 的干预措施，3）讨论可能减少 OCF 的策略，以及 4）简要讨论政策影响。OCF 是由于了解或接触过量用药相关危害而产生的痛苦，在社区层面上，可能会妨碍合作和适应性机构有效应对。当 OCF 发生在社区层面时，它可能会产生负面影响，侵蚀对基于证据的服务的支持，并助长以污名化为驱动的政策，这些政策将责任归咎于使用药物的人。同理心是 OCF 和替代性恢复力的基础，它使人们能够理解过量用药死亡所造成的痛苦，并见证成瘾康复的喜悦。使用风险环境框架，社会环境的微观和宏观层面上的 OCF，可能会通过强调个人对减少过量用药的责任，而不是社区层面的基础设施和资源管理，增加农村社区受到伤害的脆弱性。需要进一步的研究来开发 OCF 的衡量标准，并确认 OCF 是否与农村地区增加的污名化和对减少伤害的支持减少有关。
