Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management
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- Evan D. Kharasch
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
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- J. David Clark
- the Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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- Jerome M. Adams
- Purdue University, West Lafayette, Indiana
抄録
<jats:p>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.</jats:p>
収録刊行物
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- Anesthesiology
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Anesthesiology 136 (1), 10-30, 2021-12-14
Ovid Technologies (Wolters Kluwer Health)