Steel Daniel, Tekin Şerife
Kennedy Inst Ethics J. 2021;31(3):271-301. doi: 10.1353/ken.2021.0022.
This article examines injectable Opioid Agonist Treatment (iOAT), in which patients suffering from long-term, treatment refractory opioid use disorder (OUD) are prescribed injectable diacetylmorphine, the active ingredient of heroin. While iOAT is part of the continuum of care for OUD in some European countries and in some parts of Canada, it is not an available treatment in the United States. We suggest that one reason for this situation is the belief that a genuine treatment for substance use disorder cannot prescribe the same substance as that used. We examine possible rationales for this belief by considering four combinations of views on the constitutive causal basis of substance use disorders and the definition of effective treatment. We show that all but one combination counts iOAT as a genuine treatment and that there are good reasons to reject the one that does not. Specifically, we claim that medical interventions, such as iOAT, that significantly reduce the severity of a disorder deserve to be categorized as effective treatments and regarded as such in practice.
本文探讨注射用阿片类激动剂治疗（iOAT），即针对患有长期、难治性阿片类物质使用障碍（OUD）的患者，开具注射用二乙酰吗啡（海洛因的活性成分）的治疗方法。虽然iOAT在一些欧洲国家和加拿大的部分地区是OUD连续护理的一部分，但在美国却不是一种可用的治疗方法。我们认为造成这种情况的一个原因是，人们认为针对物质使用障碍的真正治疗方法不能开具与所使用物质相同的物质。我们通过考虑关于物质使用障碍的构成性因果基础和有效治疗定义的四种观点组合，来研究这种观点的可能依据。我们表明，除了一种组合外，其他所有组合都将iOAT视为真正的治疗方法，而且有充分的理由拒绝不这样认为的那种组合。具体而言，我们声称，像iOAT这样能显著降低疾病严重程度的医学干预措施，理应被归类为有效治疗方法，并在实践中如此看待。
