Vakuru vekuAmerica vanorwisana newapioid kushandiswa
Kubvira muna 2000 kusvikira muna 2014, vanenge mamiriyoni evanhu vakafa kubva kune opioid kudarika , 165 000 kune avo vari kubva mune zvinodhaka zvinodhaka . Muna 2016, yakafungidzirwa kuti 78 vanhu veAmerica vanofa nekushandiswa kweapioid zuva rega rega. Hafu yezvi rufu izvi zvine chokuita neopioid zvinonzi kune mishonga yemishonga.
Hazvibatsiri kana uri muduku kana mukuru, mupfumi kana murombo, kushandiswa kweopioid dambudziko rinoda kutarirwa neUnited States zvachose.
Iyo Hurumende yeUnited States Inotsanangura Sei Kurapa Zvinodhaka
ICentral for Disease Control and Prevention (CDC) inoshuma kuti kudarika kufa kweapioid kwakawedzerwa kane kubva muna 1999. Zvinoshamisa kuti kushandiswa kwemishonga inonzi opioids yakawedzerawo panguva ino.
Ndiyo hurongwa hwehutano hweAmerica huri mhosva here?
Drug Enforcement Administration (DEA) inopa madhiragi kune chimwe chezvikamu zvishanu zvakasiyana, zvinonzi Sedules. Seduro I kuburikidza neV inotsanangura kana mushonga unokodzera kushandiswa kwehutano mune mamwe mamiriro uye ingave here kana kuti hauna uwandu hwemakemikari .
- Purogiramu I: Hapana kushandisa kwechiremba, simba rekuita zvepabonde
- Purogiramu II: Kushandisa kwechiremba, kukwanisa kuwedzeredza
- Purogiramu yechitatu: Kushandisa kwemishonga, kuenzanisa kusvika pakaderera kuwedzeredza
- Purogiramu IV: Kushandiswa kwechiremba, simba rekudzora mishonga
- Purogiramu V: Kushandiswa kwechiremba, simba rakaderera rinodhaka
Hazvifaniri kutishamisa kuti heroin inowira pasi pePurogiramu I (zvinonakidza, zvinoitawo mbanje ).
Mishonga yakawanda inowanikwa muChechi II ndeye codeine, fentanyl (Sublimaze, Duragesic), hydromorphone (Dilaudid), methadone, meperidine (Demerol), morphine, uye oxycodone (OxyContin, Percocet). Purogiramu III narcotics inosanganisira mishonga inobatanidza ine mamiriyoni masere e hydrocodone per dose (Vicodin), zvigadzirwa zvine makirogiramu asingasviki 90 emodhiini (Tylenol neCodeine), uye buprenorphine (Suboxone) .
Wati wambotaurirwa imwe yemishonga iyi here?
Pharmaceutical Companies Deredza Dambudziko reNhamo
Muna 2001, The Joint Commission in Accreditation of Healthcare Organizations (JCAHO) yakabudisa chirevo chekutanga chekutambudzika kwekutambudzika. Achida kuunza ruzivo rwekutambudzika kwekushungurudzwa uye nekuvandudza hutano hwekutarisira, JCAHO akaita mazano akakurudzira kuti zvipatara zvakaongororwa sei, zvakataurirwa uye zvakarapwa.
Somugumisiro, chirwere chinorwadza chakatanga kuvapo, uye kwaive nekuwedzera kwevanhu kuziva nezvekurwadziwa kwekutambudzika. Izvo, mukati uye pachayo, chinhu chikuru. Hapana munhu anofanira kunge ari kurwadziwa. Dambudziko, zvisinei, nderokuti vanhu vazhinji havana kunzwisisa kuti kurwadziwa kwaiva chii pamusoro pese. Zvaireva kuvandudza marwadzo, kwete kunyanya kuunza marwadzo kusvika kune "0" pane 0-10 scale. Kubviswa kwekutambudzika hakusi nguva dzose kunogoneka. Nezvo zvakauya kushandiswa kune hurongwa hwehutano hwekurarama hupenyu hunoenderana nezvisingatarisirwi.
Kunyange zvazvo JCAHO isina kuudza vatapi vezvehutano nzira yekurapa marwadzo, kunetseka kwakamutswa pamusoro pezvinhu izvo Komisheni yakaparadzirwa iyo yakatsigirwa nePurdue Pharma, kambani yemishonga inoita OxyContin . Zvinhu zvakaderedza kusanganiswa kwemaipioid nemishonga.
Vamiririri vezvemishonga yekambani vakaenda kusvika kureva kuti njodzi yekudhakwa yaiva "pasi pezanachete" apo yakave ichizivikanwa kwenguva refu kuti njodzi yokubatwa zvisina kunaka mune varwere vasina kenza ingasvika kune yakakwirira se50 muzana. Zvechokwadi, Purdue Pharma yakazowanikwa nemhosva yekutengesa tsika dzekutengesa uye yakagamuchira $ 634 mamiriyoni.
Zvakakosha kuziva kuti Joint Commission haisati yagovera zvinhu izvozvo kuvashandi vehutano asi yakave yakanganisa kare? JCAHO inotaura kuti kushandiswa kwemishonga inonzi opioid kwaikurira vasati vabudisa zvinyorwa zvavo asi zvakakosha kuziva kuti yakaramba ichingomuka mushure mehutano hwemarwadzo.
Zvinetso zvehurumende Zvingave Zvakagadzikana Opioid Kududzira
Muna 2006, Centers for Medicare neMedicaid Services (CMS) yakatanga Chipatara Chekuongorora kweVatano neHurumende (HCAHPS). Tsvakurudzo yakashandiswa senzira yekuongorora chirwere chechipatara uye yakapedzerwa nevarwere zvichienderana nehupenyu hwavo munguva yekugara kwavo kuchipatara.
HCAHPS inosanganisira mibvunzo pamusoro pokurwisana nekurwadziwa: "Kurwadziwa kwako kwakanyatsorongeka kangani?" uye "Vashandi vezvipatara vakaita sei zvese zvavanogona kubatsira nemarwadzo enyu?" Mhinduro idzi dziri pasi pechiratidzo uye hazvirevi izvo zvinorehwa nemurwere chaiye kugadzirisa kurwadziwa kana kana kuchengetwa kwaive kwakanyanya kunyatsokodzera. Murwere aitarisira kuti "0" pachirwere chinorwadza aigona kutarisa chipatara nechikwereti chakashata kunyange kana kurwadziwa kwake kwakavandudzika pamusoro pokugara kwake. Kunyange zvakadaro, yakanga iri nhanho mune nzira yakarurama yokunzwa kuti varwere vanoona sei kutarisira kwavo.
Dambudziko? HCAHPS zvikwata zvakabatanidzwa kuchipatara chekubhadhara mari. CMS yaizobhadhara zvipatara zvimwe kana dzaive nezvikoro zvakakwirira. Kunyange zvazvo CMS inotaura kuti mibvunzo yekudzivirira kurwadza yakapiwa zvishomanana kubhadhara, chokwadi ndechekuti dzakabatanidzwa. Kunetseka ndechokuti vamwe vashandi vehutano vanogona kunge vakanzwa vachimanikidzirwa kuti varatidze opioids kuti vawane zvidzidzo zvakakwirira.
Vachiziva kuti HCAHPS ingadai yakave yakapa zvakananga kuwedzera kushandiswa kwemishonga yeopioid, CMS yakabva yabvisa mibvunzo yekuongorora marwadzo kubva pamutambo wavo wekubhadhara. Iyo data inoenderera mberi kuunganidzwa, zvisinei, kubatsira zvipatara kunatsiridza hutano hwekutarisira nekutambudzika kwekutambudzika.
Kuwedzera kweMagareti Kuwedzerwa Kwemishonga yeOpioid
Chidzidzo che2016 muna JAMA Internal Medicine chakasimudza mashizha apo chakaratidza kuti vaMeddy vaibhadharwa vakanga vari kurongerwa kusinganzwisisiki kwemaawa opioid mushure mekugara muchipatara. Kunyanya, vatsvakurudzi vakaongorora zvipatara zvinokwana vanosvika 623 000 vaMedare muna 2011.
Vaya vanobatsirwa vakanga vasati vasvika pamishonga yeopioid, kunyanya kwete kwemazuva makumi matanhatu apfuura kuchipatara kwavo. Vanenge 15 kubva muzana vavo vakazadza mvumo itsva yeopioid mukati mevhiki imwe chete yechipatara kubudiswa uye 42,5 muzana yavo vakapfuurira pamishonga iyi kwemazuva anopfuura 90.
Kune ani zvake akabvunza kana HCAHPS yakagadzirisa zvirongwa zvepamutemo, chidzidzo chacho chakaratidza kuwirirana kwakanyanyisa pakati pekugutsikana kwepachigarire zvikamu uye zvinyorwa zvitsva zveopioid.
Chimwe chidzidzo, nguva ino muJAMA Psychiatry, yakaratidzawo nezvemaitiro. Dhiyabhorosi kubva kuna Medicare Chikamu D yakaongororwa uye yakawanikwa kuti 6 mu1000 varwere veMedare vane chirwere chekushandisa zvisina kunaka maopioid. Iyi inowedzera mazana matanhatu kuenzaniswa nevanhu kune dzimwe hurongwa hwehushuwarisi.
Chii chinoita kuti vanaMederal vabatsirwe zvakanyanya kufanana nechishuwo chekushandisa maopioid? Ichokwadi here kuti vane hurombo husingaperi? Ndizvo zvingangove zvakakosha kuiswa maopioid nekuti, sevakuru, vanofarira kuva nezvipatara zvakawanda? Munyaya iyi, HCAHPS inokanganisa here? Ongororo yakawanda inodiwa kuitira kuti tigone kusvika pamwoyo wechinetso. Hatifaniri kungozvidzivirira huputi hweupioid asiwo zvinetso zvinopoteredza.
Chii Chatingaita Kuti Tisiye Maawa Opioid Abuse?
Denda reOpioid harisi reboka rimwe chete. Zvinhu zvakawanda zvakaita kuti zvinhu izvi zvivepo, uye kubatana pakati pehurumende, makambani emishonga, makambani ehushuwarisi, masangano ezvehutano uye vashandi vehutano vachadiwa kuti vaite shanduko dzinoshanda. Aya matanho anogona kubatsira kutitungamirira munzira yakarurama.
- Nzira nemitemo haifaniri kurega kubhadharwa kuhutano hwehutano hunobva mukugutsikana kwechigarire zviitiko zvinogona kuenderana nekushandiswa kwemishonga yemishonga. Izvi zvinogona kuchinja marongerwo emitemo nenzira inobhadhara mari yakakwirira kune zvipatara.
- Kutsvakurudza kunofanirwa kuitika pakuvandudza mishonga yemazuva mashoma ekurapa zvinorwadza. Makambani emishonga uye vamwe vanoda kuisa mari kuti vandudze mikana inowanikwa.
- Vatsigiri vanofanirwa kuwedzera kugoverwa kwezvimwe zvirwere zvinorwadza. Kubata muviri, biofeedback, kurapwa kwemazuva, uye kurapa kwemuviri, somuenzaniso, vakaratidza kubatsirwa mukuvandudza mazinga ekurwa asi inshuwarisi haisi kuvanza.
- Vashandi vehutano vangada kuwedzera kumwekudzidziswa kana zvasvika pamagadzirirwo ekutambura kwepakuvara uye kushandiswa kwemishonga yepamusoro yeopioids.
- Mamwe marwadzo ekurapa anofanirwa kuongororwa pamberi pemishonga yeopioid kana zvichibvira. Kushandisa kurapa maopioid kutanga-mutsara kunogona kutungamirira kushandiswa kwemishonga iyi.
- Kuwana zvirongwa zvekuvandudza (kupa mazano, mishonga, nezvimwewo) zvinokurudzira kupora kubva mukutsvaga kweopioid zvinoda kuvandudzwa. Vanhu vanoda rubatsiro asi zvishoma zvigadziriro zvinowanika kukwanisa kukwirira kwedambudziko panguva ino.
> Sources:
> HHS Inoparidza Zvitsva Zvitsva Zvokurwisana neApioid Epidemic. Dhipatimendi reUnited Health Health and Human Services website. http://www.hhs.gov/about/news/2016/07/06/hhs-announces-new-actions-combat-opioid-epidemic.html. Yakabudiswa musi waJuly 6, 2016.
> Jena AB, Goldman D, Karaca-Mandic P. Chipatara Kurondedzera maOpioid kuMedare Vanobatsira. JAMA Intern Med. 2016; 176 (7): 990-997. doi: 10.1001 / jamainternmed.2016.2737.
> Joint Commission Chirevo pamusoro pehutano hwekutambudzika. The Joint Commission website. https://www.jointcommission.org/joint_commission_statement_on_pain_management/. Yakabudiswa musi waApril 18, 2016.
> Prescription Opioid Overdose Data. Nzvimbo dzeDaase Control and Prevention website. http://www.cdc.gov/drugoverdose/data/overdose.html. Yakaperedzwa June 21, 2016.
> Zee AV. Kukurudzira nekudhinda kweOxyContin: Kukunda kweZvashandi, Hurumende Yehutambudziko. Am J Public Health. 2009 February; 99 (2): 221-227. doi: 10.2105 / AJPH.2007.131714.