Abadala baseMerika balwa nokusetyenziswa kakubi kwe-opioid
Ukususela ngo-2000 ukuya ku-2014, phantse abantu abangaphezu kwesigidi bafa kwi- opioid overdose , abayi-165 000 abo bavela kwiidakamizwa zonyango . Ngo-2016, kwaqikelelwa ukuba ama-78 aseMerika afa ngenxa yokusetyenziswa kakubi kwe-opioid imihla ngemihla. Isiqingatha salezi zifilo ezihlobene ne-opioid kubangelwa kwiziyobisi zamachiza.
Akunandaba nokuba usemncinci okanye umdala, uyityebi okanye uhlwempuzekileyo, ukusetyenziswa kakubi kwe-opioid yinkinga efuna ukujongiswa yi-United States ngokubanzi.
Indlela uRhulumente waseUnited States echaza ngayo izidakamizwa zokulahla
Amaziko okuLawula nokuLawulwa kwezifo (CDC) ingxelo yokuba ukudlula i-deaths from opioids yandile ngokuphindwe kane ukusuka ngo-1999. Ngokuthakazelisayo, ukusetyenziswa kwe-opioids yesigxina kwanexesha eliphindwe kabini ngeli xesha.
Ngaba inkqubo yokunakekelwa kwempilo yaseMerika ibeka ityala?
Ulawulo lweNkqubo yoLwaphulo-mthetho (DEA) linikezela izidakamizwa kwenye yeeklasi ezahlukeneyo, ezibizwa ngokuba yiShedyuli. Iishedyuli I ngokusebenzisa V achaza ukuba isilwanyana sifanelekileyo ukusebenzisa izidalwa kwiimeko ezithile kwaye nokuba ngaba akunako ukulutha .
- Ishedyuli I: Akukho tyenziswa kwezonyango, amandla okulutha kakhulu
- IShedyuli II: Ukusetyenziswa kwezonyango, amandla okulutha kakhulu
- Ishedyuli III: Ukusetyenziswa kwezonyango, ukulinganisela ukuya kumgangatho ophantsi wokulutha umlutha
- Ishedyuli IV: Ukusetyenziswa kwezonyango, amandla angaphantsi kokulutha
- Ishedyuli V: Ukusetyenziswa kwezonyango, amandla angaphantsi komlutha
Akufanele kumangaliswe ukuba i-heroin iwela phantsi kweShedyuli I (ngokuthakazelisayo, ngokunjalo i- marijuana ).
I-opioids eqhelekileyo ye-opioids ewela kwiShedyuli II yi-codeine, i-fentanyl (i-Sublimaze, i-Duragesic), i-hydromorphone (i-Dilaudid), i-methadone, i-meperidine (i-Demerol), i-morphine kunye ne-oxycodone (i-OxyContin, i-Percocet). Ishedyuli ye-narcotics III ifaka iimveliso ezidibeneyo eziqukethe ii-milligram ze-hydrocodone ngaphantsi kwe-dose (Vicodin) ezingaphantsi kwama-15, iimveliso ezinama-milligram engaphantsi kwama-90 e-codeine ngomthamo (iTylenol neCodeine) kunye ne- buprenorphine (i-Suboxone) .
Ngaba uke wachazwa enye yale miyeza?
AmaNkampani aMachiza amancinci Ukunciphisa ingozi yokuLungisa
Ngo-2001, i-Joint Commission ye-Accreditation of Healthcare Organisations (JCAHO) yakhiphela isitatimende sayo sokuqala ngolawulo lweentlungu. Injongo yokuzisa ulwazi ngentlungu engaphathwa kakubi kunye nokuphucula umgangatho wokunyamekela, i-JCAHO yenza iziphakamiso ezithintele ukuba izibhedlele ziqwalaselwe njani, ziqwalaselwe kwaye ziphathwa kakubi.
Ngenxa yoko, isalathisi sentlungu yaba khona, kwaye kwaba nolwazi olwandisiweyo loluntu malunga nokulawula ubuhlungu. Oko, ngaphakathi kwayo, yinto enkulu. Akukho mntu kufuneka abe entlungu. Noko ke, inkathazo kukuba abantu abaninzi abazange bakuqonde ukuba kuthethwa ngantoni na. Kwakuthetha ukuphucula intlungu, kungekhona ukuzisa amanqanaba entlungu ukuya "kwi-0" kwisilinganiso se-0-10. Ukupheliswa kwentlungu ayisoloko inokwenzeka. Ngaloo nto yafika ingcinezelo kwinkqubo yokunakekelwa kwezempilo ukuze iphile ngokulindelekileyo.
Ngelixa i-JCAHO ingazange ixelele ababoneleli ngezempilo ukuba baphathe njani intlungu, inkxalabo yaphakanyiswa malunga nezinto ezikhutshwe yiKomishoni ezaxhaswa yi-Purdue Pharma, inkampani yezobisi eyenza i- OxyContin . Izinto zanciphisa ikhonkco phakathi kwamayeza opioid kunye nomlutha.
Abameli bezobisi beli nkampani baye bathi ukubeka umngcipheko kwaba "ngaphantsi kwepesenti enye" xa bekude kwaziwa ukuba umngcipheko wokusetyenziswa gadalala kwizigulane ezingekho komhlaza zingafikelela kuma-50 ekhulwini. Enyanisweni, i-Purdue Pharma kamva itholakala enetyala lokuthengisa okulahlekisayo kwaye ihlawulwe i-$ 634 yezigidi.
Kubalulekile ukuba uqaphele ukuba iKomishini ehlangeneyo ayisasabalali loo mveliso kubaqeqeshi bezempilo kodwa yenzeke umonakalo okwenziwe ngaphambili? I-JCAHO ithi ukusetyenziswa kwe-opioid kwimiyalelo yokunyuka komzimba ngaphambi kokukhishwa kweengxelo zabo kodwa kubalulekile ukuqaphela ukuba yaqhubeka iphakama emva kwesilinganiselo seentlungu.
Iingqinisiso Zomgaqo-karhulumente Zingathi Ziye zachaphazelekayo Ukuchazela i-Opioid
Ngo-2006, amaziko e-Medicare kunye neeNkonzo zeMedicaid (CMS) aqalise ukuVavanywa kwabathengi beZibhedlele beMpilo kunye nabaSebenzi (HCAHPS). Uphando lwasetyenziswa njengendlela yokuhlola ukusebenza kwebhedlele kwaye igqitywe zizigulane ezisekelwe kumava abo ngexesha lokuhlala esibhedlele.
I-HCAHPS iquka imibuzo malunga nokulawulwa kabuhlungu: "Ixesha elide ulwaphule kangakanani intlungu?" kwaye "Abasebenzi besibhedlele babenza kaninzi kangako konke ukunceda ngentlungu yenu?" Iimpendulo zithobela kwaye akumele zimelele oko isiguli esifumene ngokwenene ekulawuleni ubuhlungu okanye ukuba ukunyamekelwa kwakungowona uphezulu. Isigulane esilindele "u-0" kwisikali sentlungu singalinganisa isibhedlele ngamanqaku aphantsi nangona intlungu yakhe yayiphuculwe ngaphezu kokuhlala kwakhe. Sekunjalo, kwakuyinqanaba elona ndlela efanelekileyo ukuva ukuba izigulane zaziqonda njani ukunakekelwa kwazo.
Ingxaki? Iinqununu ze-HCAHPS zidibaniswe namazinga okubuyisela izibhedlele. I-CMS yayiza kubhatala izibhedlele xa zifumana amanqaku aphezulu. Ngelixa i-CMS ibanga ukuba imibuzo yokulawula ubuhlungu inokuba negalelo elincinane kwinkokhelo, inyaniso kukuba bafakiwe. Ixhalaba kukuba abanye abaqeqeshi bezempilo baye baziva bexinzelelwe ukuba bacele i-opioids ukufezekisa amanqaku aphezulu.
Ukuqaphela ukuba i-HCAHPS ingaba negalelo ngokuthe ngqo ekusebenziseni i-opioid esebenzayo, i-CMS sele isuswe imibuzo yokuhlola intlungu ebukhosini bayo. Idata iyaqhubeka iqokelelwa, nangona kunjalo, ukunceda izibhedlele ziphucule umgangatho wokunyamekela nokulawulwa kwintlungu.
Ukusetyenziswa kweMithi yeeDove eyandisiweyo
Ucwaningo olwenziwa ngo-2016 kwiJAMA lwangaphakathi lweMicrothelo luphakamise iilebe xa luchaza ukuba abaxhamli be-Medicare bebekelwe umlinganiselo ongeyantoni yeyeza opioid emva kokuhlala esibhedlele. Ngokukodwa, abaphandi baphonononga izibhedlele ezimalunga nama-623,000 abaxhamli be-Medicare ngo-2011.
Aba baxhamli babengekho ngaphambili kwiyeza ze-opioid, ubuncinane kungekhona kwiintsuku ezingama-60 ezandulela ukuhlala kwabo esibhedlele. Phantse iipesenti ezili-15 zazo zazalisa imithi entsha ye-opioid kwisonto elilodwa lokukhutshwa kwesibhedlele kwaye amaphesenti angama-42,5 aqhubekayo kuloo mayeza angaphezu kweentsuku ezingama-90.
Kuba nabani na obabuza ukuba i-HCAHPS ichaphazele iipatheni zogqirha, isifundo sibonisa ukulungelelaniswa okuthobekileyo phakathi kwamanqaku anelisayo kunye neemfuno ezintsha ze-opioid.
Olunye uvavanyo, ngeli xesha kwi-JAMA Psychiatry, libonise ngokumalunga nokuhamba. Idata evela kwi-Medicare Part D yahlolwa kwaye kwafunyanwa ukuba aba-6 000 kwi-Medicare abaxhamli banokukhubazeka kwe-opioid. Oku kukunyuka kwexesha ezintandathu ngokuthelekiswa nabantu abakwezinye izicwangciso ze-inshorensi.
Kutheni i-Medicare abaxhamli bexhamla ngakumbi kwi-opioid? Ngaba ngokwenene banentlungu engapheliyo? Ngaba banako ukufakwa kwi-opioids ngenxa yokuba, njengabadala, bavame ukufumana izibhedlele ezininzi? Ngaloo nto, i-HCAHPS ibeka ityala? Kufuneka uphando olungakumbi ukuze sikwazi ukufikelela entliziyweni yengxaki. Akufuneki ukukhusela kuphela ukusetyenziswa kakubi kwe-opioid kodwa kunye neengxaki ezikujikelezayo.
Yintoni esinokuyenza ukuze siyeke ukusetyenziswa kakubi kwe-Opioid?
Ubhubhane lwe-opioid alukho nawaphi na elinye iqela. Iziganeko ezininzi ezikhokelela kule meko yezinto, kunye nentsebenziswano phakathi koorhulumente, iinkampani zonyango, iinkampani zomshuwalense, iinkqubo zezempilo kunye nababoneleli ngeenkonzo zezempilo kuya kufuneka ukuba benze utshintsho olufanelekileyo. Ezi nyathelo zinokusinceda ukusishukumisela ngendlela efanelekileyo.
- Imigaqo kunye nemimiselo akufanele ivumele ukubuyisela kwiinkqubo zononophelo lwezempilo ezisekelwe kwizikolo ezinelisekisa izigulane ezinokuthi zihambelane nokusetyenziswa kwezidakamizwa. Oku kunokutshintsha iipatheni zonyango ngendlela ebonisa iintlawulo eziphezulu kwizibhedlele.
- Uphando lufanele lwenziwe ukuze kuphuhliswe unyango olutsha olungaphantsi kwezilonda. Iinkampani zamachiza kunye nabanye kufuneka batyalole imali yokwandisa ukhetho olukhoyo.
- Abatshutshisi kufuneka banwebe ukwandiswa kweengxaki zonyango. I-Acupuncture, i-biofeedback, i-massage therapy, kunye neyeza zonyango, umzekelo, zibonise inzuzo ekuphuculeni umgangatho weentlungu kodwa i-inshorensi ayisoloko ifihla.
- Ababoneleli ngezezempilo bangadinga uqeqesho olongezelelweyo xa kufikelelwe kubuchule bokulawulwa kweentlungu kunye nokusetyenziswa kwe-opioids.
- Ezinye iintlobo zentlungu kufuneka ziqwalaselwe phambi kweyeza ze-opioid xa kunokwenzeka. Ukusebenzisa iindlela zokwelapha opioid wokuqala umgca kunokwenzeka ukuba kukhokelela ekusebenziseni okuqhubekayo kwala mayeza.
- Ukufikeleleka kwiiprogram zokuvuselela (ukucebisa, imithi, njl.) Ezikhuthaza ukuphulukana nokusetyenziswa kakubi kwe-opioid kufuneka ziphuculwe. Abantu badinga uncedo kodwa ulwabiwo-mali luncinci lubakho ukujongana nobukhulu beengxaki ngeli xesha.
> Imithombo:
> I-HHS izisa iiNtshukumo ezitsha zokulwa noKhuselo lwe-Opioid. ISebe lezeMpilo leSebe lezeMpilo yaseMzantsi Afrika. http://www.hhs.gov/about/news/2016/07/06/hhs-announces-new-actions-combat-opioid-epidemic.html .Ipapashwe ngoJulayi 6, 2016.
> Jena AB, i-Goldman D, iKaraca-Mandic P. Isibhedlele Ukuchaza ii-opioids kumayeza abaxhamlileyo. JAMA Intern Med. 2016; 176 (7): 990-997. i-doi: 10.1001 / jamainternmed.2016.2737.
> Inkcazo yokuThunywa kweKhomishoni yoLawulo lwePain. IQumrhu leKhomishini elidibeneyo. https://www.jointcommission.org/joint_commission_statement_on_pain_management/. Ipapashwe ngo-Apreli 18, 2016.
> Idatha ye-Opioid Overdose Data. Amaziko okuLawulwa kweNtsholongwane kunye noThintelo lweSifo. http://www.cdc.gov/drugoverdose/data/overdose.html. Ukuhlaziywa ngoJuni 21, 2016.
> Zee AV. Ukukhuthazwa kunye nokuThengiswa kwe-OxyContin: Ulwaphulo loRhwebo, iNtlekele yezeNtlalo. Ngaba J Zempilo Yoluntu. 2009 ngoFebruwari; 99 (2): 221-227. i-doi: 10.2105 / AJPH.2007.131714.