From the Department of Medicine, University of British Columbia, Vancouver, BC V6H 0A5, Canada, (SP, SN, LT); British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada, (SN, LT); Providence Health Care, Vancouver, BC V6Z 1Y6, Canada, (TM); Faculty of Pharmaceutical Sciences, University of British Columbia, 2405Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada, (TM).
J Addict Med. 2022;16(4):386-388. doi: 10.1097/ADM.0000000000000938. Epub 2021 Oct 21.
The opioid-driven overdose crisis has had devastating effects across North America, resulting from a complex interplay between individual, social-structural, and environmental factors. Changing approaches to pain management, increased heroin use, and potent synthetic opioids infiltrating the drug supply are compounded by both lack of access to opioid use disorder treatment and surrounding stigma. Inappropriate opioid prescribing practices in healthcare settings have played a central role, and in recent years, there has been increasing interest in implementing hospital-based opioid stewardship programs aimed at improving safety and monitoring opioid prescribing. There is a range of approaches taken by these programs, ranging from audit and feedback to consult services; however, a significant focus of many of these programs is on medication restriction. Such measures stand to negatively impact the care of people with complex healthcare needs, including those currently on long-term opioid therapy, and those with increased opioid tolerance. In this commentary, we emphasize the importance of creating opioid stewardship programs focused on appropriate pain treatment rather than solely on medication restriction to both appropriately prescribe to and manage pain in people who use illicit drugs. This population faces many barriers to care, such as unique dose requirements and high interpatient variability that "one size fits all" stewardship cannot appropriately address. Additionally, opioid stewardship programs that use patient-centered strategies such as multi-disciplinary consult services have been shown to lead to positive health outcomes and have significant potential to address the current shortcomings in pain management for people who use illicit drugs.
阿片类药物驱动的药物过量危机对北美产生了毁灭性的影响，这是个人、社会结构和环境因素之间复杂相互作用的结果。改变疼痛管理方法、海洛因使用增加以及强效合成阿片类药物渗透到毒品供应中，加上获得阿片类药物使用障碍治疗和周围污名的机会有限，使情况更加复杂。医疗保健环境中的不当阿片类药物处方实践发挥了核心作用，近年来，人们越来越感兴趣地实施基于医院的阿片类药物管理计划，以提高安全性和监测阿片类药物处方。这些计划采取了多种方法，从审计和反馈到咨询服务；然而，这些计划中的许多都侧重于药物限制。这些措施有可能对有复杂医疗需求的人的护理产生负面影响，包括那些正在接受长期阿片类药物治疗的人和那些对阿片类药物耐受性增加的人。在这篇评论中，我们强调创建侧重于适当疼痛治疗的阿片类药物管理计划而不是仅仅关注药物限制的重要性，以便为使用非法药物的人开具和管理疼痛。这一人群面临许多护理障碍，例如独特的剂量要求和高个体间变异性，而“一刀切”的管理无法适当地解决这些问题。此外，使用以患者为中心的策略（如多学科咨询服务）的阿片类药物管理计划已被证明可以带来积极的健康结果，并具有解决当前非法药物使用者疼痛管理不足的巨大潜力。
