RESUMEN
While U.S. opioid prescribing has decreased 38% in the past decade, opioid deaths have increased 300%. This opioid paradox is poorly recognized. Current approaches to opioid management are not working, and new approaches are needed. This article reviews the outcomes and shortcomings of recent U.S. opioid policies and strategies that focus primarily or exclusively on reducing or eliminating opioid prescribing. It introduces concepts of a prescription opioid ecosystem and opioid pool, and it discusses how the pool can be influenced by supply-side, demand-side, and opioid returns factors. It illuminates pressing policy needs for an opioid ecosystem that enables proper opioid stewardship, identifies associated responsibilities, and emphasizes the necessity of making opioid returns as easy and common as opioid prescribing, in order to minimize the size of the opioid pool available for potential diversion, misuse, overdose, and death. Approaches are applicable to opioid prescribing in general, and to opioid prescribing after surgery.
Asunto(s)
Analgésicos Opioides/efectos adversos , Prescripciones de Medicamentos/normas , Epidemia de Opioides/prevención & control , Trastornos Relacionados con Opioides/prevención & control , Salud Pública/normas , Analgésicos Opioides/administración & dosificación , Humanos , Epidemia de Opioides/tendencias , Trastornos Relacionados con Opioides/epidemiología , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/prevención & control , Salud Pública/métodosRESUMEN
Responding to the public health crisis in the United States resulting from untreated opioid use disorder (OUD) requires expanding delivery of effective treatments, including medications, and eliminating stigma against people with OUD and people seeking OUD treatment. Stigma discourages people with substance use disorders from seeking care and compromises the care they receive when they do seek it. Stigma against both medication treatments for OUD and harm-reduction approaches like syringe services programs has created additional barriers to these strategies' acceptance and use. It is ethically incumbent upon everyone in medicine and health care to recognize addiction not as a moral failing but as a treatable disease.
Asunto(s)
Trastornos Relacionados con Opioides , Instituciones de Salud , Humanos , Principios Morales , Trastornos Relacionados con Opioides/terapia , Salud Pública , Estigma Social , Estados UnidosAsunto(s)
Programas de Intercambio de Agujas/organización & administración , Abuso de Sustancias por Vía Intravenosa/epidemiología , Hepatitis/etiología , Hepatitis/prevención & control , Humanos , Servicios de Salud Mental/organización & administración , Naloxona/administración & dosificación , Antagonistas de Narcóticos/administración & dosificación , Derivación y Consulta/organización & administración , Enfermedades de Transmisión Sexual/etiología , Enfermedades de Transmisión Sexual/prevención & control , Abuso de Sustancias por Vía Intravenosa/complicaciones , Estados UnidosAsunto(s)
Cese del Hábito de Fumar , United States Public Health Service , Sistemas Electrónicos de Liberación de Nicotina , Costos de la Atención en Salud , Humanos , Fumar/economía , Fumar/epidemiología , Fumar/mortalidad , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
Slowing aging is a widely shared goal. Plant-derived polyphenols, which are found in commonly consumed food plants such as tea, cocoa, blueberry and grape, have been proposed to have many health benefits, including slowing aging. In-vivo studies have demonstrated the lifespan-extending ability of six polyphenol-containing plants. These include five widely consumed foods (tea, blueberry, cocoa, apple, pomegranate) and a flower commonly used as a folk medicine (betony). These and multiple other plant polyphenols have been shown to have beneficial effects on aging-associated changes across a variety of organisms from worm and fly to rodent and human.