Stein G L, Fleischman A R
Medical and Academic Affairs, New York Academy of Medicine, NY 10029, USA.
J Urban Health. 1998 Sep;75(3):558-83. doi: 10.1007/BF02427704.
Building on decades of Academy activities related to substance use, this report emphasizes three guiding principles: 1. Drug treatment should be accessible to all drug users seeking care, including those who are incarcerated. Because turning users away when programs are operating at or above capacity represents lost opportunities for care, programs should be prepared to commence treatment at the time users request it. 2. Addiction is a complex, chronic, relapsing illness for which various inpatient, residential, and outpatient treatments are used, depending on the substances involved, the intensity and duration of the addiction, the characteristics and tolerances of the patient, and the circumstances involved. Optimal addiction treatment requires generalists in medical care who are knowledgeable and capable in the areas of diagnosis and management; specialist consultation and care; specific programs dedicated to the acute and chronic care of drug users; and the multidisciplinary participation of appropriately qualified counselors, social workers, and other professionals. 3. Steps need to be taken to reduce the health-related harms associated with injection drug use, including the transmission of human immunodeficiency virus (HIV), hepatitis B and C, and other blood-borne pathogens. Harm reduction incorporates many modalities, such as HIV prevention education, including condom use and safer sex counseling and education; referrals for drug treatment and other health care and social services; interim methadone maintenance; and syringe and needle availability and exchange programs. Each of these interventions represents important medical and public health strategies that may decrease some of the secondary medical consequences of injection drug use.
基于美国国家科学院几十年来在药物使用方面开展的活动，本报告强调了三项指导原则：1. 所有寻求治疗的吸毒者，包括被监禁者，都应能够获得药物治疗。由于在项目满负荷或超负荷运转时拒绝吸毒者意味着失去治疗机会，项目应准备好在吸毒者提出请求时就开始治疗。2. 成瘾是一种复杂的慢性复发性疾病，针对此疾病，会根据所涉及的药物、成瘾的强度和持续时间、患者的特征和耐受性以及具体情况，采用各种住院、寄宿和门诊治疗方法。最佳的成瘾治疗需要具备医疗知识且在诊断和管理领域有能力的通科医生；专科会诊和护理；专门针对吸毒者急性和慢性护理的特定项目；以及具备适当资质的咨询师、社会工作者和其他专业人员的多学科参与。3. 需要采取措施减少与注射吸毒相关的健康危害，包括人类免疫缺陷病毒（HIV）、乙型和丙型肝炎以及其他血源性病原体的传播。减少危害包括多种方式，如HIV预防教育，包括使用避孕套和安全性行为咨询与教育；转介接受药物治疗及其他医疗和社会服务；临时美沙酮维持治疗；以及注射器和针头供应及交换项目。这些干预措施中的每一项都代表着重要的医学和公共卫生策略，可能会减少注射吸毒的一些继发性医疗后果。
