RESUMO
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.
Assuntos
Analgésicos Opioides/efeitos adversos , Prescrições de Medicamentos/normas , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Saúde Pública/normas , Analgésicos Opioides/administração & dosagem , Humanos , Epidemia de Opioides/tendências , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Saúde Pública/métodosRESUMO
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.
Assuntos
Transtornos Relacionados ao Uso de Opioides , Instalações de Saúde , Humanos , Princípios Morais , Transtornos Relacionados ao Uso de Opioides/terapia , Saúde Pública , Estigma Social , Estados UnidosAssuntos
Programas de Troca de Agulhas/organização & administração , Abuso de Substâncias por Via Intravenosa/epidemiologia , Hepatite/etiologia , Hepatite/prevenção & controle , Humanos , Serviços de Saúde Mental/organização & administração , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Encaminhamento e Consulta/organização & administração , Infecções Sexualmente Transmissíveis/etiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Abuso de Substâncias por Via Intravenosa/complicações , Estados UnidosAssuntos
Abandono do Hábito de Fumar , United States Public Health Service , Sistemas Eletrônicos de Liberação de Nicotina , Custos de Cuidados de Saúde , Humanos , Fumar/economia , Fumar/epidemiologia , Fumar/mortalidade , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
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.