Ingqwalasela yeNgxaki yeLizwe elibi kakhulu
Isifo se-opioid saseMelika sisona sibi kakhulu kwihlabathi elikhuphisayo, kubulala abantu abaninzi njengemoto ephazamisayo kunyaka ngamnye. Kwiminyaka emibini edluleyo, amawaka abantu bafa ngokungaboni ngokungaziwayo kwimiyalelo yesigqirha okanye i-painkillers ezingekho mthethweni , kwaye ezinye izigidi zaba zixhomekeke kubo. Ngenxa yoko, impilo karhulumente kunye namagosa ezonyango ezivela kuluntu kunye namaziko karhulumente e-United States asebenza ukulungisa le ntlekele yengozi yoluntu. Kodwa ibhubhane linomlando omude kwaye unzima, kwaye izisombululo aziyi kuba lula. Nakhu okumele ukwazi.
Kwenzeka ntoni
I-opioids iquka uluhlu lwezilwanyana ezichaphazela ubuhlungu kunye namaziko okuvuza obuchopho. Ezinye zala machiza zenziwe kwizityalo, ngelixa ezinye zidibeneyo.
Xa ilawulwa ngokufanelekileyo, i-opioid njenge-oxycodone, fentanyl, kunye ne-morphine ingasetyenziswa ngokukhuselekileyo. Kodwa ngenxa yokuba ezi ziyobisi zichaphazela njani intlungu kunye neenjabulo ezithandwayo kwiingqondo zethu, kunokwenzeka ukuba zixhomekeke kubo. Ngokuqhelekileyo xa usebenzisa ngaphezulu, xa ufuna ngakumbi, kwaye abantu bangaqala ukusebenzisa kakubi iziyobisi ngenxa yoko.
Ukusetyenziswa kakubi kwe-opioid yinkxalabo yempilo yoluntu ebalulekileyo eyenza ubomi abangama-91 baseMelika ngemihla. Inani lokugqithisa izidakamizwa ezifayo ezihlobene ne-opioids zanyuka kwi-2000s-quadrupling zakuqala ukususela ngo-1999-kungekho zibonakaliso zengcinezelo ekulahlekelwa ngumoya.
Kwakhona kubiza. Ixabiso le-bhubhane lafikelela kwi-dollar engama-dollar ayi-78.5 yezigidigidi ngo-2013, kodwa akukho nto ifanisa nokulahleka ubomi. Ngokwe-projection evela kwi-STAT News, ngaphandle kokuba into eyenziwe ngokukhawuleza ukukhawuleza ukunyuka kokusetyenziswa kakubi kwe-opioid, inani elininzi kwisigidi abantu bangabulawa yiziyobisi kwiminyaka elishumi ezayo.
Ukusebenzisa iziyobisi zonyango xa zingakhange zibekwe enye yeendlela eziqhelekileyo abantu basebenzise kakubi i-opioids, kodwa kwiminyaka yamuva iinguqu ezingekho mthethweni ze-opioid ebizwa ngokuthi i-fentanyl kunye nezinye iziyobisi ezifanayo ezikhukhula kwiimarike ziye zenza umlutha ngakumbi. Ngaphandle kolawulo olufanelekileyo okanye ukulawulwa kwezonyango, abasebenzisi banokubeka ingozi kwi-overdosing. Kwaye kunye nokunyuka okulindelekileyo ukuya kwiMedicaid kunye noMthetho woNonophelo olungabonakaliyo, kulindeleke ukuba abantu abaninzi baya kulahlekelwa yinshurensi yabo yempilo kunye nokufikelela kwonyango-ukuqhuba abanye ukuba bafune iinguqu ezingekho mthethweni zamachiza kunye nokwandisa imeko esele ibuhlungu.
Ngubani ochaphazelekayo
Akuyena wonke umntu osebenzisa i-opioids okanye awaxhomekeke kuye. Xa zilungiswe kakuhle kwaye phantsi kolawulo lwezonyango, i- painkillers yesigqirha ingalawulwa ngokukhuselekileyo. Yilapho ukusetyenziswa kungakhange kuhlolwe okanye xa izidakamizwa zenziwe ngokungekho mthethweni ukuba abantu bangahlakulela i-Opioid Use Disorder (OUD).
I-OUD ibonakala ehlukileyo kubantu abahlukeneyo. Kwabanye, kunokuthetha nje ukuthanda i-opioids okanye ukuthatha okungaphezulu kunokuba kuhlosiwe, kodwa kwabanye, i-OUD iphumela ekuvaleni ihlabathi okanye uvumele ubomi bakho bube bucala ngenxa yokusetyenziswa kwe-opioid. Ukuba awunalo uchwepheshe wezokwelapha ekuncedeni ukugcina umthamo phantsi kolawulo okanye uqinisekise i-opioid oyisebenzisayo ikhuselekile, ubeka umngcipheko wokugqithisa.
Kwaye oku kwenzeka kakhulu. Ukugqithiswa kwezidakamizwa okwangoku kubangela ukufa kwabantu abangaphantsi kwama-50 e-United States, kunye neyesishumi kwi-10 ngaphezulu kwezidakamizwa ziquka i-opioids. Nangona le ngxaki ixhaphake kulo lonke ilizwe, ezinye iindawo zixhomekeke kwiopioid overdoses ngaphezu kwabanye. I-Rust Belt, i-Appalachia, kunye ne-New England ibona amazinga aphezulu okuchithwa kweziyobisi ngaphezu kwelamaThafeni, umzekelo.
Abantu abancinci kubonakala bengenakuchaphazeleka ngokungafani nentsholongwane. Ngokwe-2016 ingxelo ye-Abusebisi yeMpahla kunye noLawulo lweeNkonzo zezeMpilo yengqondo, kulinganiselwa ukuba izigidi ezi-2 ezilutsha eziseneminyaka eli-18 ukuya kwe-25 ubudala i-opioids engasetyenziswa kakubi kunyaka owedlule-ephezulu kunanoma yiphina inqanaba leminyaka.
Yintoni mhlawumbi ininzi malunga nolwazi lwezempilo loluntu yinani labaselula abachaphazelekayo. Ngama-900 000 aneshumi elivisayo eliphakathi kweminyaka engama-12 ukuya kwe-17 ubudala, i-opioids ingasetyenziswa kakubi ngo-2016. Nangona le nto isezantsi kwi-million yezigidi ngo-2015, inani liyamangalisa, ingakumbi ekucingeni ukuba abaninzi abaselula abasetyenziswa kakubi kwezi ziyobisi zibakhulule kubahlobo okanye izalamane.
Nangona abatsha abantu bengasasebenzisi kakubi i-opioid, abadala abadala abakwazi ukuzivikela. Abongezelelweyo abayizigidi ezili-1,8 baseMerika kuma-50 abo basebenzisa kakubi iziyobisi ngo-2016, ukwanda ukusuka kwi-1.7 yezigidi ngo-2015.
Ubulili bubonakala ngathi budlala indima. Okwangoku, amadoda angaphantsi kokufa ngenxa yokugqithisa kwee-painkillers, kodwa oko kubonakala kuguqulwa. Phakathi kuka-1999 no-2010, inani labasetyhini abafa kwi-painkillers lonyango landa ngamaphesenti angama-400, xa kuthelekiswa nokunyusa kwama-237 ekhulwini ekufeni kwabantu. Abasetyhini banakho amathuba kunokuba amadoda atyunjwe kwaye asebenzise i-opioids ngentlungu, okwenza iqela elikhuselekileyo xa lifika kulo bhubhane. Uninzi lwabantu abathatha i-opioids-nangona iinguqu ezingekho mthethweni njenge heroin-zenza njalo kuba zibuhlungu ngenxa yezinto ezifana nomhlaza okanye ukulimala kanobom.
Indlela Esifumane Ngayo: Imbali emfutshane
Ngaphambi kwee-1980, abasebenzi bezonyango baqeqeshwe ukuba banike ii-opioids ezimbalwa ngokunokwenzeka ngenxa yentlungu ngenxa yokwesaba kokuxhomekeka. Ngenxa yoko, abantu abaneentlungu ezingapheliyo baphathwa ngokunyanisekileyo. Kuwo wonke ama-1980, iincwadana zamanqaku zanyatheliswa emva kokucinga ukuba imithi yonyango iya kubangela ukuxhomekeka kwaye ikhuthaze oogqirha, endaweni yoko, ukuba bacinge kwakhona indlela yabo yokuphepha ukusetyenziswa kwexesha elide le-opioids ukuze baphathe ubuhlungu obungapheliyo.
I-pendulum isuka. Ngenxa yokukhuthazwa kweenkampani zonyango, oogqirha abaninzi baqala ukuchaza i-opioids kwizigulane zabo, kwaye iMelika yabona i-spike enkulu kwinani lokungabikho ngokweqile lokufa kwabantu abangenakuzenzela kwi-painkillers. Ngasekupheleni kwee-1990, i-alamu yahamba, kwaye i-pendulum yaqala ukuguqula enye indlela. Oogqirha baphinde baphinda bawaphula imiyalelo ngaphandle kokulumkisa. Ngo-2006, oogqirha babhala imiyalelo ye-opioid engama-72 e-100 yabantu base-United States. Kwiminyaka elishumi kamva loo nombolo yaba ngama-66.5 kubantu abayi-100 ngo-2016.
Njengoko umlinganiselo wemigqaliselo yonyango echanekileyo yehlile, isantya se-opioids esingafanelekanga kunye nesicatshulwa. Xa i-opioid echazwe yomekile okanye yaba yindleko kakhulu, ezinye izigulane zaphendukela kwi-heroin njengenye indlela eshibhile. Ngo-2010, amagosa aqala ukubhalisa ama-spikes kwi-heroin ephezulu, elandelwa kwiminyaka embalwa emva kwee-overdoses ezivela kwi-fentanyl (IMF) engekho mthethweni. Njengoko enye ingxaki ibonakala ilawulwa phantsi, omnye ukhawuleza ukuba athathe indawo yakhe kwimidlalo eyiyo-whack-mole-mole.
Iimbali zabantu ziye zatshintshwa. Ukugqithiswa kwee-opioid esetyenziselwa ukuchaphazela abantu abamhlophe kwi-30s kunye no-40, kodwa iimpawu zikhomba ukutshintshwa kwala manani njengoko abantu abatsha baqala ukuzama ukusetyenziswa kunye nokusetyenziswa kakubi kwemithi kunye neepilisi ezingekho mthethweni.
Indlela esinokuyilungisa ngayo: Umbono wezeMpilo kaRhulumente
Njengemibandela yempilo kawonkewonke yoluntu, akukho sisombululo esilula kwi-opioid epidemic. Ukuchasana nokusetyenziswa kakubi kwezi zi yobisi kuza kuthatha indlela eyahlukeneyo yoluleko equka bonke abantu abangabodwa kunye namaziko amakhulu karhulumente.
UMboneleli kunye neMfundo yeMonde
Inxalenye ebalulekileyo yokukhawuleza ukusetyenziswa kakubi kwee-painkillers zonyango kufuneka ifake ukufundisa izigulane ezithatha ezi zi yobisi ngokubaluleka kolawulo olufanelekileyo kunye nokulawulwa kwezonyango, kunye neengozi zokuxhomekeka nokugqithisa. Izigulane kufuneka zithathele iingcebiso ngokuqhubekayo malunga nendlela yokugcina imimiselo yazo ngokufanelekileyo ukukhusela iipilisi zisetyenziswa kakubi ngabahlobo okanye intsapho-ingakumbi abaselula.
Ukongezelela, uninzi lwabantu abasebenzisa i-opioids bathi zenza njalo kuba luyabanceda baphathe intlungu engapheliyo. Ngokuxhomekeka kubukhulu beentlungu, ukungahambi kahle kunokukwazi ukulawulwa ngeentlungu ezixhamlayo kwi-acetaminophen (iTylenol) okanye i-ibuprofen, okanye imithi engeyonyango njengonyango lomzimba okanye i-hypnotherapy. Abanye bathi ukufundisa oogqirha kunye nezigulane malunga nokusetyenziswa kwamanyathelo okulawula iintlungu kunokuncedisa ukunciphisa inani le-opioids elimiselwe ngokukhupha zonke iinketho ezingenayo i-opioid kuqala nokushiya i-painkillers njengemvume yokugqibela.
Ukunyuka koLiso
Eminye imiba yenkqubo ingabangela umngcipheko wezinto ezingapheliyo ezingalindelekanga, ezifana noogqirha abaninzi abhala izikripthi okanye iifommesi ezininzi ezizalisa imiyalelo ye-opioid. Ngokugcina iithebhu kwizinto ezibekiwe, ubuninzi, kwaye ngubani, onokunciphisa umngcipheko wee-painkillers zonyango ukuba zisebenzise kakubi. Amanye amazwe asele aqalise ukuphumeza inkqubo enjalo yokubeka esweni impumelelo enkulu, nangona iinkcukacha zeenkcukacha kunye neengxelo ziyakwazi ukuhluka ukusuka kurhulumente ukuya kwimeko.
Akunjalo nje ngemigqaliselo, nangona kunjalo. Inani lokufa ngokwexesha elidlulileyo ngenxa ye-opioids engafanelekanga njenge-heroin iye yaphazamisa iminyaka emininzi edlulileyo. Idatha engakumbi kulezi zi yobisi, kubandakanywa nabasetyenziswayo kwaye apho zisasazwa khona, zinokunceda amagosa angcono ukuba aqonde indlela kwaye iindawo ezijoliswe ngayo kwiinkalo ngokufanelekileyo.
Unyango
Akwanele ukunqumla ukunikezelwa kweepioid. Kufuneka kwakhona ufumane uncedo kubantu abaye baxhomekeka. Okumangalisayo kukuba, enye yezona ndlela ezigqithiseleyo zokunqoba i-opioid disorder disorder is to use medicines lessened opioid njengenxalenye yenkqubo eyaziwa ngokuba yiNyango yokuNcediswa kweMithi (MAT). Ezi zonyango mayeza amathathu avunywe yi-Food and Drug Administration ukuphatha uxhomekeke kwi-opioid: i-methadone, i-buprenorphine, kunye nokukhululwa kwe-naltrexone.
Nangona ukuphumelela kwala mayeza kunokungafani, uphando lubonise ukunciphisa ukuthembela kwimizimba kwi-opioids kwaye kunceda abo bakwiinkqubo ezithinteleyo ukunyaniseka ukuxhomekeka. UMAT, nangona kunjalo, akufanele kube yinkqubo yonyango kuphela. Ngenxa yokuba ukuxhomekeka kunokubakho izixhobo zomzimba kunye nokuqonda, iinkqubo zonyango ziyabona impumelelo enkulu xa zijongana nazo zonke iinkalo zokuxhomekeka.
Ukunyanga imiba yokusetyenziswa kweziyobisi kungekhona nje ukugcina ubomi, kubakho utyalo-mali olulungileyo. Kuqikelelwa ukuba kuzo zonke i-$ 1 ezichithwe ngokusetyenziswa kwezilwanyana kwi-United States, singasindisa phakathi kwe-$ 4 ne-7 kwiindleko ezinxulumene nolwaphulo-mthetho.
UkuNciphisa
Ngaphandle kwezicwangciso ezikhankanywe apha ngasentla, ezi zinto ziza kuthatha ixesha, kwaye ngokuqinisekileyo ziya kuba ngabantu abaqhubekayo ukusebenzisa kakubi i-opioids nangona kukho imizamo engcono kakhulu yoluntu lwempilo noluntu. Inkqubo encinane, kodwa ebalulekileyo, ingaba ukubonelela iintsapho kunye nabahlobo babasebenzisi ngeekiti zokuhlangula xa kwenzeka ukunqongophala kokunciphisa umngcipheko wokufa.
Lapho Sivela Kulapha
Ngo-Oktobha ka-2017, uMongameli uDonald Trump wabuza iSebe lezeMpilo lase-United States kunye neenkonzo zoLuntu ukuba zivume umbandela ngokumemezela i-opioid isifo esixakekileyo sezempilo. Ikhomishoni ye-White House ye-opioids yakhupha ingxelo emva kokuba ichazwe iingcebiso eziphambili malunga nokuba zivela ngaphi, zibandakanya iziphakamiso zokutshintshwa kwenkqubo kunye neenkqubo eziza kwenziwa nguMthetho we-White House kunye neCongress.
Ezinye iinkampani karhulumente sele zibeke phambili iinjongo zabo zendlela abanokulwa ngayo nentsholongwane. Ngenxalenye yalo, i-FDA ichaze isicwangciso senzo ukusuka kumbono wokulawula. Isicwangciso sesicwangciso-sixhenxe siquka ukudala ikomiti yeengcebiso, ukongeza amaleyibhile okulumkisa kwi-opioids, kwaye ufuna iinkampani zoshishino ukuba ziphande iimpembelelo zexesha elide lokusebenzisa i-opioids.
Amacandelo okuLawula nokuVikela (i-CDC) kwakhona akhupha izikhokelo zamagqirha phambi, ngexesha, nangemva kokubhala umyalelo we-opioid. Kuzo, i-agunya ikhuthaza oogqirha ukuba baphishekele ezinye iintlobo zonyango lokuqala, njengezonyango zomzimba kunye namajoni e-steroid, kwaye sebenzisa i-opioids kuphela njengendlela yokugqibela yonyango.
Isisombululo esinobuchule kwinqanaba likaRhulumente sibonise isithembiso sangaphambili. UMaspala, umzekelo, uye wandisa ukufikelela kumachiza kunyango ngokusebenzisa imodeli yomphathi we-nurse evumela oogqirha ukuba baphathe izigulane ezininzi kunokuba ngaba ngabaphathi abaziintloko. Enye inkqubo eMaldsburg ixhomekeke kubasebenzi bezentlalo njengenkxaso kumaqela ogqirha ukufikelela abantu abaninzi kwaye ukunciphisa ulwahlulo lwamayeza.
Ezi nkqubo ziya kubaluleka ngakumbi njengoko utshintsho luye lwacetyiswa kwaye lwenziwa kuMthetho woNonophelo olunganakuncedo kunye neenkqubo zooncedo lukaRhulumente ezifana neMedicaid. Ngenxa yokuba ulawulo lwezonyango lubaluleke kakhulu ekuncedeni izigulane ukulawula intlungu yazo ngokukhuselekileyo nangempumelelo, ukufikelela kwiinkonzo zempilo ezinokungenaxabiso kuya kuba yinto ebalulekileyo kwanoma yiyiphi na imizamo yokulwa nesibhubhane.
> Imithombo:
> Amacandelo okuLawula nokuLawula izifo. Ingxelo Yonyaka yoNyaka-mali yeengozi kunye neziphumo ezinxulumene neziyobisi-eMelika, ngo-2017. Ingxelo eNgqapheliyo yeeNgxelo 1. IiNkonzo zokuLawula kunye nokukhusela, iSebe lezeMpilo neSebe lezeMpilo. Ishicilelwe ngo-Agasti 31, 2017. Kufumaneka ngo-Disemba 18, 2017.
> Amacandelo okuLawula nokuLawula izifo. Ukugqithisa i-opioid: Ubume be-epidemic. Kufumaneka ngoDisemba 18, 2017.
> Connery H. Unyango olwenziwe ngonyango lwe-opioid ukusetyenziswa kwengxaki: ukuhlaziywa kobungqina kunye nezikhokelo ezizayo. I-Harvard Rev ye-Psychiatry . 2015; 23 (2): 63-75.
> NIDA. Imigaqo yeNyango yokuLungiswa kweziyobisi: I-Guide Based Based Guide (I-Edition YesiThathu) . ISikole seSizwe kwiwebhusayithi yokusetyenziswa kakubi kweziyobisi. Kushicilelwe ngoDisemba 1, 2012. Kufumaneka ngo-Disemba 18, 2017.
> Rudd RA, uSeth P, uDavid F, uScholl L. Ukunyuka kweDrug kunye neOpioid-Ukuxhatshazwa kokugqithiswa kwezidumbu - United States, 2010-2015. I-MMWR I-Morb Mortal Wkly Rep . IPub: 16 Disemba 2016. INGXELO: http://dx.doi.org/10.15585/mmwr.mm655051e1