Chirongwa cheNyika Dambudziko Rakanyanya Kupindwa Muropa neMishonga
IAmerica's opioid epidemic ndiyo yakaipisisa munyika yakashambadzirwa, inouraya inenge vanhu vakawanda sekutengesa motokari gore negore. Kwemakumi maviri emakore adarika, zviuru zvevanhu zvakafa nekusarura zvisingafungidziki pamutemo kana kuti painkillers dzisiri pamutemo , uye mamwe mamiriyoni akazova akavimba navo. Somugumisiro, hutano hwehutano uye vezvehutano vanobva mumharaunda uye masangano ehurumende kumativi ose eUnited States ari kushanda kuti agadzirise dambudziko iri rehutano hwehutano hwevanhu vose. Asi denda rine nhoroondo yakareba uye yakaoma, uye mhinduro haizouya nyore. Heino izvo zvaunofanira kuziva.
Chii Chiri Kuitika
Opioids inosanganisira mhando yezvinodhaka zvinokanganisa marwadzo uye zvipo nzvimbo dzeuropi. Mimwe yemishonga iyi inogadzirwa kubva kumiti, asi imwe inogadzirwa.
Kana yakarongeka zvakakodzera, maopioid akafanana nexycodone, fentanyl, uye morphine anogona kushandiswa zvakanaka. Asi nekuda kwekuti mishonga iyi inobata sei kurwadziwa uye kugamuchira mafaro muuropi yedu, zvinokwanisika kuva vakavimba navo. Kazhinji paunowedzera kuvashandisa, iwe unowedzera kuvada, uye vanhu vanogona kutanga kushandisa zvinodhaka izvozvi.
Kushandiswa zvisina kufanira kweipioid chirwere chakakomba chehutano hwevanhu chinotora hupenyu hwevanhu 91 veAmerica zuva rega rega. Nhamba yekufa kwechirwere chechirwere ichi chakakonzerwa neopioid yakasimbiswa mumavambo 2000s-quadrupling kubvira muna 1999-isina zviratidzo zvekushaiwa kwemafu.
Izvo zvinodhura. Mutengo wechirwere wakasvika ku $ 78.5 mabhiriyoni emadhora muna 2013, asi hapana chakaenzanisa nemararamiro akarasika. Maererano nehuwandu hunobva ku STAT News, kunze kwekunge chimwe chinhu chakaitwa nokukurumidza kudzivisa kuwedzerwa kwewapioid zvisina kunaka, vazhinji vehafu yevanhu vanogona kuurayiwa nemishonga iyi mumakore gumi anotevera.
Kushandisa mishonga inorayirirwa kana vasati varayirwa ndeimwe yenzira dzakajairika vanhu vanoshandisa maopioid, asi mumakore achangopfuura kushandiswa kwemaopioid kusingabvumirwi kunonzi fentanyl nemimwe mishonga yakadaro inowedzera mumusika yakaita kuti uwedzere kunyanya kuuraya. Pasina kutungamirirwa kwakakodzera kana kutarisirwa kwechiremba, vashandi vanogona kuisa pangozi kudarika. Uye pamwe nekuwedzerwa kunotarisirwa kuMedicaid uye Affordable Care Act, zvinotarisirwa kuti vamwe vanhu vacharasikirwa nehutano hwavo hwehutano nekusvika kuchipatara-kutyaira vamwe kutsvaga shanduro dzisina kukodzera yemishonga uye kuwedzera mamiriro ezvinhu akaoma.
Ndiani Ari Kutaridzirwa
Haasi munhu wese anoshandisa opioid anovashandisa zvisina kunaka kana kuti anovimbiswa. Kana zvakanyatsoiswa uye pasi pekutarisirwa kwezvechiremba, chirongwa chepamusoro chepiniki chinogona kupiwa zvakachengeteka. Ndiko kushandiswa kusingatariswi kana kana mishonga yakagadzirwa zvisina kukodzera kuti vanhu vagone kukura Opioid Use Disorder (OUD).
OUD inotarisa zvakasiyana nevanhu vakasiyana. Kune vamwe, zvinogona kungoreva kuda maopioid kana kutora zvinopfuura izvo zvakatarwa, asi kune vamwe, OUD inogumisa mukuvhara pasi rose kana kurega hupenyu hwako huchigumburwa nekuda kwekushandisa kwako opioid. Kana iwe usina unyanzvi hwezvokurapa uchikubatsira kuti uchengetedze mairi pasi pekutonga kana kuti uone kuti opioid yaunoshandisa yakachengeteka, iwe unomira mukana wekudarika.
Uye izvi zvinowanzoitika zvikuru. Zvinodhaka zvinodhaka iye zvino ndiyo inokonzera rufu rwevanhu vari pasi pe50 muUnited States, uye matanhatu kubva kune gumi zvinodhaka zvinodhaka zvinosanganisira opioids. Kunyange zvazvo dambudziko iri rakapararira munyika yose, dzimwe nzvimbo dzakanyanya kufanana neopioid overdoses kupfuura vamwe. IRust Belt, Appalachia, uye New England vanoona mazinga akawandisa ekuderedza zvinodhaka kudarika maArains, somuenzaniso.
Vechidiki vanoita sevanopesana nehuwandu hwehutachiona. Maererano nemushumo we2016 weHuman Substance Abuse uye Mental Health Services Administration, inofungidzirwa kuti mamiriyoni maviri evanhu vaduku vane makore 18 kusvika ku25 vakashandisa zvisina kufanira opioid mugore rapfuura-rakakwirira pane rimwe boka rezera.
Ndezvipi zvimwe zvakanyanya pamusoro pehutano hwehutano hwehutano nhamba yevechiri kuyaruka inobatanidzwa. Vanenge vanenge 900 000 vari kuyaruka vane makore 12 kusvika ku17 vari kushandiswa zvisina kumira maopioid muna 2016. Uye kana ichi ichidzika kubva kubva munenge mamiriyoni muna 2015, nhamba ichi ichiri kutyisa, zvikurukuru tichifunga kuti vakawanda vari kuyaruka vanoshandisa zvinodhaka izvi vanovabhadhara pasina shamwari neshamwari.
Kunyange zvazvo vechidiki vasingaiti zvisina kunaka maopioid, vakuru vakwegura havazivi. Zvimwe mamiriyoni 1.8 eAmerica mumakore avo makumi mashanu vakashandisa zvisina kunaka madhiragi muna 2016, kuwedzera kubva mamiriyoni 1,7 muna 2015.
Gender inoratidzika seinoita basa. Pari zvino, varume vanowanzofa nekuda kwekudarika kwechirwere chepiritsi, asi izvo zvinoita sezviri kuchinja. Pakati pe1999 na2012, nhamba yevakadzi vakafa nemishonga yekurapa inowedzera 400 kubva muzana, kana ichienzaniswa ne 237 muzana yekufa kwevakafa pakati pevarume. Vakadzi vanewo huwandu hunopfuura varume vanorayirwa uye vanoshandisa maopioid pamarwadzo, vachiita kuti ivo vanyanyogadziriswa kana zvichiuya kune chirwere ichi. Iyo yakawanda yevanhu vanotora opioid-kunyange shanduro dzakashata se heroin-vanozviita nokuti vari mukutambudzika nekuda kwezvinhu zvakadai sekenza kana kukuvara kwakanyanya.
Maitiro Atinayo Pano: Nhoroondo Pfupi
Musati ma1980, vashandi vezvokurapa vakadzidziswa kupa maopioid mashomanana sezvinobvira kurwadziwa nekuda kwekutya kwekuvimba. Somugumisiro, vanhu vane marwadzo asingagumi vakanyatsotambudzwa. Munyika dzose dzema1980, nyaya dzakatevedzana dzakabudiswa dzichidzokorora shure kwekufunga kuti mishonga inorwadza yaizoita kuvimba uye kukurudzira vanachiremba, pane kudaro, kuongorora zvakare tsika yavo yekurega kushandisa kwenguva refu maopioid kurapa kurwadziwa kusingaperi.
Iyo pendulum inoputika. Nekukurudzirwa kwemakambani emishonga, vamwe vanachiremba vakatanga kutora maopioid kune varwere vavo, uye America yakaona tsanga yakawanda muhuwandu hwekufa kwevanhu vasingaiti nemaune kubva pamagetsi ekurapa. Mukupera kwema1990, mazamu akabuda, uye pendulum yakatanga kudzokera shure neimwe nzira. Vanachiremba zvakare vakagadzirisa zvinyorwa zvakare kubva kumuchenjeri. Muna 2006, vanachiremba vakatora mitemo 72.4 yeopioid yevanhu vese 100 muUnited States. Makumi gumi gare gare nhamba iyoyo yakawira 66.5 pavanhu 100 mu 2016.
Sezvo muyero wemirairo yakakodzera yezvokurapa yakaderera, muyero wezvisina kukodzera uye usina kuongororwa opioid wakakwira. Paakanyorerwa maopioid yakaoma kana kuti yakanyanya kudhura, vamwe varwere vakashandura heroin seimwe nzira inodhura. Muna 2010, vakuru vehurumende vakatanga kutora zvinyorwa mu heroin overdoses, vakatevera makore mashomanana gare gare nekudarika kwepamutemo kubva kune zvakashata-zvakagadzirwa fentanyl (IMF). Sezvo rimwe dambudziko rinoratidzika riri kutora pasi, mumwe anokurumidza kutora nzvimbo yawo mumutambo chaiyo we whack-a-mole.
Madhimoni akachinja zvakare. Kuwedzerwa kweiiyooidhi kunoshandiswa kukanganisa vanhu vatsvene mumakore makumi matatu nemakumi matatu, asi zviratidzo zviri kuratidza kuchinja kune avo vanoverengeka sezvo vechidiki vanotanga kuedza uye kushandisa zvisina kunaka mishonga uye zvipembenene zvinorambidza.
Nzira Yatingagona Kuigadzirisa: Inhu Huzhinji Hwehutano
Kufanana nehutano huzhinji hwehutano hwevanhu, hapana sarudzo iri nyore kune chirwere cheopioid. Kurwisana nokusashandiswa kwemishonga iyi kunotora nzira dzakasiyana-siyana dzinosanganisira vose kubva kune vasina kuroorwa kune masangano makuru ehurumende.
Mupi uye Murembere Dzidzo
Chimwe chikamu chekuwedzera kushandiswa kushandiswa zvisina kunaka kwezvinodhaka zvinodhaka zvinotarisirwa kusanganisira kudzidzisa varwere vanotora mishonga iyi mukukosha kwekutarisira kwakanaka uye kutarisirwa kwechiremba, uye ngozi dzekuvimba uye kudarika. Varwere vanofanira kupiwazve mazano ekunyatsochengetedza mitemo yavo yekudzivirira mapiritsi kushandiswa zvisina kufanira neshamwari kana mhuri-kunyanya vachiri kuyaruka.
Uyezve, vazhinji vevanhu vanoshandisa opioid vanoti vanoita izvozvo nokuti zvinovabatsira kuchengeta kurwadziwa kusingaperi. Zvichienderana nekuwanda kwemarwadzo, kushungurudzika kunogona kugadziriswa ne-over-the-pain relievers relievers seye acetaminophen (Tylenol) kana ibuprofen, kana kuti isiri mishonga mishonga seyomuviri kana kuti hypnotherapy. Vamwe vanotaura kuti kuvadzidzisa vanachiremba nevarwere pamusoro pezvinoitika kune dzimwe nzira dzokugadzirisa zvinorwadza zvinogona kubatsira kuderedza nhamba yeopioid inorayirwa nekuderedza zvese zvisingaiti maopioid kutanga uye kusiya mishonga yekurapa pachinoshandiswa sechisarudzo chekupedzisira.
Kuwedzera Kuongorora
Mamwe masangano ehurongwa anogona kuve mungozi yezvinhu zvisingadiwi zvisingatarisirwi, zvakadai sechiremba vakawanda vanonyora zvinyorwa kana ma pharmacy akawanda anozadza maikoro opioid. Nokuchengeta mavhesi pane zvinenge zvichirondedzerwa, zvakadini, uye kuna ani, zvingaderedza dambudziko remishonga inorwara yepamusoro inoshandiswa zvisina kunaka. Dzimwe nyika dzakatotanga kushandisa zvirongwa zvekuongorora zvakadaro kubudiriro yakawanda, kunyange zvazvo nhoroondo uye zvichemo zvingave zvingasiyana kubva kune imwe nyika kuenda kune imwe nzvimbo.
Haisi kungova mitemo, zvisinei. Nhamba yekufa kwekufa kwepamusoro nekuda kweopioid isina kukodzera se heroin yakawedzera pamusoro pemakore akawanda akapfuura. Nhamba yakawanda pamusoro pemishonga iyi, kusanganisira ndiani ari kushandisa uye kwavari kugoverwa, inogona kubatsira vakuru vakuru kuti vanzwisise kuti sei uye kupi kunotarisa zvigadzirwa zvakanaka kwazvo.
Kurapa
Hazvina kukwana kubvisa kupiwa kweopioid. Iwewo unoda kuwana rubatsiro kune vanhu vakatova vakavimbika. Zvinoshamisa kuti imwe yenzira dzakanakisisa dzekukunda kushandiswa kwemishonga yeopioid ndeyokushandisa mishonga isingakanganisi maopioid sechikamu chekuita kunozivikanwa seMishonga Assisted Treatment (MAT). Zvitatu mishonga yakadaro yakagamuchirwa neKudya uye Drug Administration kuti ichengetedze kuvimba kweopioid: methadone, buprenorphine, uye yakawedzerwa-kusunungurwa naltrexone.
Kunyange zvazvo kubudirira kwemishonga iyi kunogona kusiyana, zvidzidzo zvakavaratidza kuderedza kuvimba kwepanyama kune maopioid uye kubatsira avo vari mukushanda kwakasimba kukunda kuvepo. MATE, zvisinei, haafaniri kunge ariyo chete nzira yekurapa. Nokuti kuvimba kunogona kuva nezvinhu zviviri zvepanyama uye zvinonzwisisika, mapurogiramu ekurapa anoona kubudirira zvakanyanya kana vakatarisa zvinhu zvose zvekuvimba.
Kurapa zvinhu zvinoshandiswa pakushandisa zvinhu hakusi kungoponesa upenyu chete, uyewo mari yakanaka yekutsvaga mari. Inofungidzirwa kuti mari imwe neimwe inoshandiswa pakushandiswa kwezvinhu zvinoshandiswa muUnited States, tinogona kuchengetedza pakati pe $ 4 ne $ 7 mumatongerwo emhosva.
Kukuvadza Kunokuvadza
Kunyangwe nezvose zvataurwa pamusoro apa, zvinhu izvi zvinotora nguva, uye pachako pachava vanhu vanoramba vachishandisa zvisina kufanira opioid pasinei nekuedza kwakanakisisa kwevanhu vezvehutano nehutano hwevanhu. Chinhu chiduku, asi chinokosha, chinogona kuva kupa mhuri neshamwari dzevashandi nekununura makikiti kana zvichiitika kudarika kuderedza dambudziko rekufa.
Kwatinobva Kubva Iko
Muna Gumiguru ra2017, Mutungamiri Donald Trump vakakumbira Dhipatimendi reMweya weUnited States neHuman Services kuti vabvume dambudziko racho nekuzivisa chirwere cheOpioid chirwere chehutano hwehutano. Imwe yeropa reOpio's opioids rakabudisa mushumo pasina nguva mushure mokurondedzera mazano makuru pamusoro pekuenda kupi pano, kusanganisira mazano ekugadzirisa nekugadziriswa kwematongerwe enyika kunotungamirirwa ne White House administration neCongress.
Mamwe masangano ehurumende akatotaurira vavariro dzavo dzekuti vangakunda sei chirwere ichi. Kune chikamu chayo, FDA yakaronga chirongwa chekuita kubva pamutemo wekutonga. Izvo zvirongwa zvinomwe zvinosanganisira kuumba komiti yekupa mazano, kuwedzera mavaraira ekunyevera pamakemikari epioid, uye ichida makambani ekumishonga kuti aongorore kushandiswa kwenguva refu kwekushandisa maopioid.
ICentral for Disease Control and Prevention (CDC) yakabudisawo mazano kune vanachiremba kare, panguva, uye mushure mokunyora mishonga yeopioid. Mavari, sangano rinokurudzira vanachiremba kuti vatevere mamwe maitiro ekurapa kutanga, zvakadai sokurapa muviri uye steroid injection, uye kushandisa opioid sekupedzisira-kushandiswa kurapwa kwemarwadzo.
Nzira dzakagadziriswa pamatunhu enyika dzakaratidza chipikirwa chekare zvakare. Massachusetts, somuenzaniso, yakawedzera kuwanika kwemishonga yerapi kuburikidza nemuenzaniso wevatapi vezviremba inobvumira vanachiremba kuti vabate varwere vakawanda kupfuura kana vari ivo vatungamiriri vakuru. Imwe hurongwa muMadganist leverages social workers sekutsigira mapoka ezvokurapa kusvika kuvanhu vakawanda uye kuderedza kushandiswa kwemishonga.
Aya mapurogiramu achave achikosha zvakanyanya sezvo kuchinjwa kunorongwa uye kunogadziriswa kune Affordable Care Act uye zvirongwa zvehurumende sekuita Medicaid. Nokuti kutarisirwa kwechiremba kunokosha kuti vabatsire kutarisa marwadzo avo akachengeteka uye zvakajeka, kusvikirwa kwehutano hwakanaka hwehutano huchava chikamu chinokosha chepi zvese uye zvose zvinoedza kurwisa denda.
> Sources:
> Centres for Disease Control and Prevention. Annual Surveillance Report of Danger-Related Related Risks and Outcomes - United States, 2017. Kuongororwa Mharidzo Inokosha 1. Zvivako zveMishonga Kudzora nekudzivirira, Dhipatimendi reMweya reUnited States uye Human Services. Yakabudiswa musi waAugust 31, 2017. Yakasvika musi waDecember 18, 2017.
> Centres for Disease Control and Prevention. Kuwedzerwa kweOpioid Overfose: Kubva pane chirwere. Yakasvika musi waDecember 18, 2017.
> Connery H. Mishonga-inobatsira kurapwa kweapioid kushandiswa kwemishonga: kuongorora kwehuchapupu nehupenyu hunotevera. Harvard Rev wePsychiatry . 2015; 23 (2): 63-75.
> NIDA. Nheyo dzeDrug Addiction Treatment: Bhuku reKutsvakurudza-Rakagadzirirwa (Chechitatu Gwaro) . National Institute on Drug Abuse website. Yakabudiswa musi waDecember 1, 2012. Yakasvika musi waDecember 18, 2017.
> Rudd RA, Seth P, David F, Scholl L. Kuwedzerwa mune zvinodhaka uye opioid-Kubatanidzwa kwekufa kwehupfumi - United States, 2010-2015. MMWR Morb Mortal Wkly Rep . Pub: 16 December 2016. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1