Compton Wilson M, Wiley Tisha, Blanco Carlos
National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Service, Bethesda, MD, USA.
J Gen Intern Med. 2020 Dec;35(Suppl 3):891-894. doi: 10.1007/s11606-020-06267-2. Epub 2020 Nov 3.
Interventions and research to address the US opioid crisis have, for the most part, targeted opioid use, misuse, and addiction specifically. While such a focus can lead to useful innovations in the care of opioid use disorder, the fact that many persons with opioid use disorder use multiple substances (both over their life course and simultaneously in drug-using episodes) makes it imperative to address broader issues of addiction in persons who have opioid use disorder as their presenting concern. Because of integrated care and the ability to target multiple clinical concerns in parallel, the Veterans Administration (VA) may be uniquely situated to address the key issue of multi-morbidity that persons with opioid use disorder so frequently exhibit. Research at the VA can build on new interventions developed by the National Institutes of Health (and others) and can help to determine the best ways to implement these interventions. Research at the VA does not need to duplicate efforts supported by other funders but can complement such work by providing an integrated platform for determining the best approaches to implementing innovations. The real-world learning health system that has been developed in the VA is poised to contribute in just such important ways.
为应对美国阿片类药物危机而开展的干预措施和研究，在很大程度上专门针对阿片类药物的使用、滥用和成瘾问题。虽然这种关注能够在阿片类药物使用障碍的治疗方面带来有益的创新，但许多患有阿片类药物使用障碍的人会使用多种物质（在其整个生命过程中以及在吸毒发作时同时使用）这一事实，使得解决以阿片类药物使用障碍为主要问题的人群中更广泛的成瘾问题变得势在必行。由于综合护理以及能够同时针对多种临床问题，退伍军人事务部（VA）可能处于独特的地位来解决阿片类药物使用障碍患者经常出现的多重疾病这一关键问题。退伍军人事务部的研究可以借鉴美国国立卫生研究院（及其他机构）开发的新干预措施，并有助于确定实施这些干预措施的最佳方法。退伍军人事务部的研究无需重复其他资助者支持的工作，而是可以通过提供一个综合平台来确定实施创新的最佳方法，从而对这类工作起到补充作用。退伍军人事务部建立的真实世界学习健康系统正准备以这种重要方式做出贡献。
