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在传染病诊疗过程中为注射吸毒者提供减少伤害服务的机会:叙述性综述

Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review.

作者信息

Peckham Alyssa M, Young Erika H

机构信息

School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA.

Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA.

出版信息

Open Forum Infect Dis. 2020 Oct 20;7(11):ofaa503. doi: 10.1093/ofid/ofaa503. eCollection 2020 Nov.

Abstract

Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include (1) teaching and distribution of materials related to safer injection practice such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and postexposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.

摘要

药物过量(OD)率上升和血源性感染与注射吸毒(IDU)有关。注射吸毒相关传染病(ID)之间这种日益增加的重叠是阿片类药物过量危机的一个副产品,特别是随着向起效更快、持续时间更短的合成阿片类药物的转变,导致注射可能更加频繁。注射吸毒问题专家具有独特的地位,可通过利用在与注射毒品者(PWID)临床接触期间的机会性接触时刻,对阿片类药物过量危机产生积极影响。因此,应扩大减少伤害服务,并在注射吸毒问题治疗机构向注射毒品者提供此类服务,以降低药物过量、感染和住院率。主要目标领域包括:(1) 传授和分发与更安全注射做法相关的材料,如无菌注射用品、芬太尼检测试纸和纳洛酮;(2) 加强暴露前预防和暴露后预防的筛查及获取;(3) 启动阿片类药物使用障碍的药物治疗。将这些策略纳入各种治疗环境可以扩大治疗机会、改善患者预后并减少与注射吸毒相关的污名。

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