Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
the Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Anesthesiology. 2022 Jan 1;136(1):10-30. doi: 10.1097/ALN.0000000000004065.
While U.S. opioid prescribing has decreased 38% in the past decade, opioid deaths have increased 300%. This opioid paradox is poorly recognized. Current approaches to opioid management are not working, and new approaches are needed. This article reviews the outcomes and shortcomings of recent U.S. opioid policies and strategies that focus primarily or exclusively on reducing or eliminating opioid prescribing. It introduces concepts of a prescription opioid ecosystem and opioid pool, and it discusses how the pool can be influenced by supply-side, demand-side, and opioid returns factors. It illuminates pressing policy needs for an opioid ecosystem that enables proper opioid stewardship, identifies associated responsibilities, and emphasizes the necessity of making opioid returns as easy and common as opioid prescribing, in order to minimize the size of the opioid pool available for potential diversion, misuse, overdose, and death. Approaches are applicable to opioid prescribing in general, and to opioid prescribing after surgery.
尽管美国在过去十年中减少了 38%的阿片类药物处方，但阿片类药物死亡人数却增加了 300%。这种阿片类药物悖论并未得到充分认识。目前的阿片类药物管理方法不起作用，需要新的方法。本文回顾了美国最近主要或专门关注减少或消除阿片类药物处方的阿片类药物管理政策和策略的结果和缺点。它介绍了处方类阿片类药物生态系统和阿片类药物库的概念，并讨论了如何通过供应方、需求方和阿片类药物回收因素来影响该库。它阐明了迫切需要建立一个阿片类药物生态系统的政策，以实现适当的阿片类药物管理，确定相关责任，并强调使阿片类药物回收像开具阿片类药物处方一样容易和常见的必要性，以最大程度地减少可供潜在滥用、误用、过量和死亡的阿片类药物库的规模。这些方法适用于一般的阿片类药物处方，也适用于手术后的阿片类药物处方。
