Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, USA.
Department of Rehabilitative Sciences and Technology, University of Wisconsin, Milwaukee, USA.
Subst Abuse Treat Prev Policy. 2022 Jul 21;17(1):55. doi: 10.1186/s13011-022-00480-4.
Beginning in the 1990s, nonmedical use of prescription opioids (POs) became a major public health crisis. In response to rising rates of opioid dependence and fatal poisonings, measures were instituted to decrease the prescription, diversion, and nonmedical use of POs including prescription drug monitoring programs (PDMPs), pain clinic laws, prescription duration limits, disciplining doctors who prescribed an excessive number of POs, and the advent of abuse deterrent formulations of POs. This paper explores the unintended effects of these policies in the descriptions of why people who use opioids transitioned from PO to injection or heroin/fentanyl use.
We conducted 148 in-depth-interviews with people who use prescription opioids nonmedically, fentanyl or heroin from a rural, urban and suburban area in three states, Connecticut, Kentucky and Wisconsin. Interviews with people who use opioids (PWUO) focused on how they initiated their opioid use and any transitions they made from PO use to heroin, fentanyl or injection drug use.
The majority of participants reported initiating use with POs, which they used for medical or nonmedical purposes. They described needing to take more POs or switched to heroin or fentanyl as their tolerance increased. As more policies were passed to limit opioid prescribing, participants noticed that doctors were less likely to prescribe or refill POs. This led to scarcity of POs on the street which accelerated the switch to heroin or fentanyl. These transitions likely increased risk of overdose and HIV/HCV infection.
A careful analysis of how and why people say they transitioned from PO to heroin or fentanyl reveals many unintended harms of policy changes to prevent overprescribing and diversion. Results highlight the importance of mitigating harms that resulted from policy changes.
20 世纪 90 年代初，非医疗用途的处方类阿片（PO）开始成为一个主要的公共卫生危机。为了应对阿片类药物依赖和致命中毒率的上升，采取了一系列措施来减少处方、转移和非医疗用途的 PO，包括处方药物监测计划（PDMP）、疼痛诊所法、处方持续时间限制、对开出过多 PO 的医生进行纪律处分，以及出现了阿片类药物的滥用抑制配方。本文探讨了这些政策在描述为什么使用阿片类药物的人从 PO 转为注射或海洛因/芬太尼使用的原因方面的意外影响。
我们对来自康涅狄格州、肯塔基州和威斯康星州三个州的农村、城市和郊区的 148 名非医疗使用处方类阿片、芬太尼或海洛因的人进行了深入访谈。对使用阿片类药物的人的访谈重点关注他们如何开始使用阿片类药物，以及他们从 PO 使用向海洛因、芬太尼或注射药物使用的任何转变。
大多数参与者报告称，他们开始使用 PO，用于医疗或非医疗用途。他们描述说，随着他们的耐受性增加，需要服用更多的 PO 或改用海洛因或芬太尼。随着更多限制阿片类药物处方的政策出台，参与者注意到医生开处方或续方的可能性降低。这导致 PO 在街头供应短缺，加速了向海洛因或芬太尼的转变。这些转变可能增加了过量用药和 HIV/HCV 感染的风险。
仔细分析人们所说的从 PO 向海洛因或芬太尼转变的方式和原因，揭示了防止过度处方和转移的政策变化带来的许多意外危害。结果强调了减轻政策变化带来的危害的重要性。
