Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL, 618202, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Curr Pain Headache Rep. 2022 Feb;26(2):129-137. doi: 10.1007/s11916-022-01010-4. Epub 2022 Feb 18.
This review aims to summarize risks and disparities associated with the prevalence and treatment of opioid use disorder in the perioperative and long-term setting, as well as evidence-based treatment and prevention targeted toward specific vulnerable populations.
There are significant demographic disparities in pain management and development and management of OUD in the chronic and surgical setting. While White patients traditionally receive more pain management, they are also at higher risk of developing OUD. Hispanic and Latin populations have the largest proportion of youth with OUD and often lack culturally appropriate translation services that allow for effective treatment. Native Americans have the second highest rate of OUD and often receive care in communities and healthcare settings that lack funding and resources to combat OUD. African Americans tend to suffer from the criminalization of OUD and are less able to seek treatment due to this, and furthermore, often lack community services that would benefit them. Additional vulnerable populations include homeless individuals that lack access to healthcare or health insurance. In addition, incarcerated individuals often lack access to naloxone and suffer from high rates of fatal overdose soon after being released to the community. People in rural settings lack needle-exchange programs and community-based interventions/support groups. Patients in the perioperative setting lack standard screening and pain management protocols. Interventions targeted toward each appropriate group can help decrease the rate of OUD and improve its treatment, and overarching interventions such as protocols, targeted funding, education and regulation can combat OUD for all populations.
目的综述：本综述旨在总结围手术期和长期阿片类药物使用障碍（OUD）的流行和治疗相关风险和差异，以及针对特定弱势群体的循证治疗和预防措施。
最新发现：在慢性和手术环境中，在疼痛管理以及 OUD 的发展和管理方面存在显著的人口统计学差异。虽然白人患者传统上接受更多的疼痛管理，但他们也有更高的发展 OUD 的风险。西班牙裔和拉丁裔人群中患有 OUD 的青年比例最大，而且往往缺乏能够实现有效治疗的文化上适当的翻译服务。美洲原住民的 OUD 发病率位居第二，而且往往在缺乏资金和资源来治疗 OUD 的社区和医疗机构中接受治疗。非裔美国人往往受到 OUD 定罪的影响，因此更难以寻求治疗，此外，他们往往缺乏对他们有益的社区服务。其他弱势群体包括无法获得医疗保健或医疗保险的无家可归者。此外，被监禁者通常无法获得纳洛酮，并且在被释放到社区后不久就会因过量而死亡。农村地区的人们缺乏针具交换计划和社区为基础的干预措施/支持小组。围手术期患者缺乏标准的筛查和疼痛管理方案。针对每个适当群体的干预措施可以帮助降低 OUD 的发生率并改善其治疗效果，而针对所有人群的总体干预措施，如方案、针对性资金、教育和法规，可以对抗 OUD。
