全球范围内护士在阿片类药物使用障碍（MOUD）药物辅助治疗方面的处方实践：范围综述。
Nurse prescribing practices across the globe for medication-assisted treatment of the opioid use disorder (MOUD): a scoping review.
机构信息
School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
Florida Department of Health, Tallahassee, USA.
出版信息
Harm Reduct J. 2023 Jun 23;20(1):78. doi: 10.1186/s12954-023-00812-y.
BACKGROUND
Despite the dramatic increase in opioid-related deaths in recent years, global access to treatment remains poor. A major barrier to people accessing Medication-assisted treatment of the opioid use disorder (MOUD) is the lack of providers who can prescribe and monitor MOUD. According to the World Drug Report, more young people are using drugs compared with previous generations and people in need of treatment cannot get it, women most of all. Nurse prescribers have the potential to enhance both access and treatment outcomes. Nurse prescribing practices do, however, vary greatly internationally. The aim of this scoping review is to explore nurse prescribing practices for MOUD globally with a view to informing equitable access and policies for people seeking MOUD.
METHODS
This scoping review was informed by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-ScR). Electronic searches from 2010 to date were conducted on the following databases: PsycInfo, PubMed, Embase, and CINAHL. Only studies that met the eligibility criteria and described nurse prescribing policies and/or behaviours for MOUD were included.
RESULTS
A total of 22 articles were included in the review which found several barriers and enablers to nurse prescribing of MOUD. Barriers included legislation constraints, lack of professional education and training and the presence of stigmatizing attitudes. Enablers included the presence of existing supportive services, prosocial messaging, and nurse prescriber autonomy.
CONCLUSION
The safety and efficacy of nurse prescribing of MOUD is well established, and its expansion can provide a range of advantages to people who are dependent on opiates. This includes increasing access to treatment. Nurse prescribing of MOUD can increase the numbers of people in treatment from 'hard to reach' cohorts such as rural settings, or those with less financial means. It holds significant potential to reduce a wide range of harms and costs associated with high-risk opiate use. To reduce drug-related death and the global burden of harm to individuals, families, and communities, there is an urgent need to address the two key priorities of nurse prescriber legislation and education. Both of which are possible given political and educational commitment.
背景
尽管近年来阿片类药物相关死亡人数急剧增加，但全球获得治疗的机会仍然很差。人们获得阿片类药物使用障碍（MOUD）药物辅助治疗的主要障碍是缺乏能够开处方和监测 MOUD 的提供者。根据《世界毒品报告》，与前几代人相比，现在有更多的年轻人在使用毒品，而且需要治疗的人无法获得治疗，尤其是女性。护士从业者有可能提高获得治疗的机会和治疗效果。然而，国际上护士开处方的做法差异很大。本范围综述的目的是探讨全球范围内用于 MOUD 的护士处方实践，以期为寻求 MOUD 的人提供公平的获得途径和政策。
方法
本范围综述以系统评价和元分析扩展的首选报告项目（PRISMA-ScR）为依据。从 2010 年至今，在以下数据库中进行了电子检索：PsycInfo、PubMed、Embase 和 CINAHL。仅纳入符合资格标准并描述 MOUD 护士处方政策和/或行为的研究。
结果
共纳入 22 篇文章，发现 MOUD 护士处方的几个障碍和促进因素。障碍包括立法限制、缺乏专业教育和培训以及存在污名化态度。促进因素包括现有的支持性服务、亲社会信息传递和护士处方自主性。
结论
MOUD 护士处方的安全性和有效性已得到充分证实，其扩展可以为依赖阿片类药物的人提供一系列优势。这包括增加获得治疗的机会。MOUD 护士处方可以增加来自农村地区或经济条件较差等难以接触人群的治疗人数。它具有显著的潜力，可以减少与高危阿片类药物使用相关的各种伤害和成本。为了减少与药物相关的死亡和个人、家庭和社区的全球伤害负担，迫切需要解决护士处方立法和教育这两个关键优先事项。只要有政治和教育方面的承诺，这两者都是可能的。
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