Njira Zisanu Zothandizira Mliri wa Opioid, Gawo 2 la 2

Malinga ndi lipoti la US Centers for Disease Control and Prevention (CDC), mu 2016, anthu 65,000 ku United States adamwalira chifukwa chomwetsa mankhwala osokoneza bongo - kuposa omwe adaphedwa pa Nkhondo ya Vietnam [1] - kuwonjezeka pafupifupi 19% kuposa anthu 54,786 adalemba chaka chatha. [2] Ambiri mwa anthu omwe amwalira chifukwa cha mankhwala osokoneza bongo amachokera ku opioid.

Pa Okutobala 26, 2017, Purezidenti Trump adalamula Unduna wa Zaumoyo ndi Ntchito za US kuti alengeze kuti vuto la opioid ladzikoli ndi vuto lazachipatala pansi pa Public Health Services Act. Ngakhale izi ndizofunikira, sizinaperekedwe chilolezo kuntchito zadzidzidzi kapena kukhazikitsa njira zenizeni. Idatsutsana ndi lonjezo lomwe Purezidenti adapanga mu Ogasiti kulengeza a zadzidzidzi mdziko lonse pa ma opioid, dzina lomwe likadatsogolera kugawa ndalama kwa feduro. Kuphatikiza apo, sanatchule pang'ono zakufunika kokulira mtengo kwa kupezeka kwa mankhwala osokoneza bongo komwe ndikofunikira kuthana ndi mliriwu.

Osalakwitsa: palibe zipolopolo zamatsenga ndipo palibe zothetsera mwachangu mavutowa. Komabe, pali zinthu zingapo zofunika kuzichita kuti muchepetse kuwonongeka kwake kwa anthu, mabanja, ndi madera, ndikuthandizira kuti tithe kupita patsogolo pazothetsera mavutowo.

1) Ikani chithandizo chamankhwala choyambirira pakumangidwa ndi kutsekeredwa m'ndende

Zina mwazovuta kwambiri zomwe zikuthandizira mliri wa opioid ndikuti ndikosavuta kukwera kuposa kupeza thandizo. Kubwezeretsa mtengo wa Care Act (ACA, aka Obamacare) kungakulitse kusiyana uku, kuchotsa chithandizo chothandizidwa ndi Medicaid kwa anthu masauzande ambiri omwe ali ndi vuto losokoneza bongo. Ntchito zina zochepetsera ndalama za Medicaid zidzakhalanso ndi zotsatira zake. M'malo mopitiliza kuyesa kuwononga ACA, ndalama zomwe zimapangitsa kuti anthu azitha kupeza mankhwala osokoneza bongo ayenera kuwonjezeka, ndipo mayiko ambiri akuyenera kulimbikitsidwa kuti athandizire kukulitsa kwa ACA kwa Medicaid.

Ogwira ntchito zazamalamulo m'maiko 30 tsopano akutenga nawo mbali mu Police Assisted Addiction and Recovery Initiative (PARRI), yomwe imapereka chithandizo kwa ogwiritsa ntchito mankhwala osokoneza bongo omwe amapempha thandizo kwa oyang'anira zamalamulo. [3] M'malo mongoyang'ana zaupandu womwe umadza chifukwa chogwiritsa ntchito mankhwala osokoneza bongo, kudzera mu PARRI, oyang'anira zamalamulo amayang'ana kwambiri kupeza anthu omwe angawathandize, kuyeserera komwe kumawononga ndalama zochepa komanso kumapereka zotsatira zabwino kuposa kumangidwa (kumabwerezedwa mobwerezabwereza) ndikumangidwa.

2) Kuthandizira ndikukulitsa chithandizo chothandizidwa ndi mankhwala (MAT)

Kafukufuku wowonjezera akuwonetsa kuti imodzi mwanjira zothandiza kwambiri zochiritsira mankhwala opioid ndikupitilira njira zochiritsira m'malo mwa methadone ndi buprenorphine. Monga gawo la njira yomwe ikufuna kuchepetsa mavuto m'malo molimbikira kudziletsa kwathunthu, kugwiritsa ntchito mankhwalawa kumathandiza kuchepetsa kuyambiranso komanso mavuto azachipatala omwe ali ndi vuto losokoneza bongo, kukulitsa kuthekera kwa anthu kugwira ntchito ndikumanganso miyoyo yawo. Tsoka ilo, ndi ochepa okha omwe amalandira mankhwala osokoneza bongo ku US omwe ali ndi mwayiwu.

MAT ilibe zovuta zake, komabe. Methadone ndi buprenorphine iwonso ndi ma opioid omwe ali ndi kuthekera kokonda kugwiritsa ntchito mankhwala osokoneza bongo-ngakhale kuli kwakuti kwa buprenorphine, pang'ono (mosiyana ndi kwathunthu) opioid agonist. Momwemonso, MAT imagwiritsidwa ntchito ngati mlatho womwe umathandiza anthu pang'onopang'ono kusiya pang'onopang'ono mankhwala osinthira ndikusinthira ku kudziletsa. Momwe zingathere, iyenera kukhala yocheperako nthawi m'malo mokhala ndi ulamuliro wokhala ndi moyo wautali.

3) Wonjezerani kupezeka kwa naloxone

Ogwiritsa ntchito opioid ayenera kukhala ndi moyo nthawi yayitali kuti athe kupeza chithandizo chamankhwala. Ngakhale kuti tsopano ali ovomerezeka m'maiko ena komanso kuchuluka kwamatauni kuti anyamule ndikuwayang'anira, oyankhira oyamba ndi zipinda zadzidzidzi nthawi zambiri amakhala alibe naloxone-mankhwala omwe amalimbana ndi opioid overdoses. Naloxone ndi wotsutsana ndi opioid-kutanthauza kuti amamangiriridwa ndi opioid receptors ndipo amatha kusintha zotsatira za ma opioid. Ikhoza kubweretsanso wina kumoyo, kubwezeretsa kupuma kwabwinobwino kwa anthu omwe kupuma kwawo kudachepa kwambiri kapena kuyimitsidwa chifukwa chogwiritsa ntchito mankhwala osokoneza bongo a opioid kapena heroin. Mabungwe azachipatala aboma ndi boma akuyenera kukambirana mitengo yotsika ndikuwonjezera mwayi wa naloxone. Chofunikira, monga nthawi yolemba, CVS akuti ikupereka naloxone popanda mankhwala m'maiko 43 ndipo Walgreens yalengeza kuti ipanga naloxone yopanda mankhwala m'malo ake onse.

4) Lonjezani zina zothandizira kuchepetsa mavuto

Boma likuyeneranso kuwonongera ndalama zambiri posinthanitsa singano ndi kuyeretsa masingano kuti athane ndi matenda opatsirana omwe amafalikira ndikugawana singano. Kuchulukitsa kugwiritsa ntchito mankhwala osokoneza bongo kwa anthu omwe adasintha ma opioid mu mapiritsi kupita ku heroin ndikuthandizira kuwonjezeka kwakukulu kwa matenda a chiwindi a C. Kuchokera mu 2010 mpaka 2015, chiwerengero cha matenda opatsirana a hepatitis C atsopano opezeka ku CDC chachuluka pafupifupi katatu. [4] Hepatitis C pakadali pano imapha anthu ambiri kuposa matenda ena aliwonse opatsirana omwe afotokozedwa ku CDC. Pafupifupi anthu 20,000 aku America adamwalira ndi zomwe zimayambitsa matenda a hepatitis C mu 2015, anthu ambiri azaka 55 kapena kupitilira apo. Matenda atsopano a kachilombo ka hepatitis C akuchulukirachulukira pakati pa achinyamata, pomwe pali anthu ambiri azaka 20 mpaka 29. [5]

5) Phunzitsani ndikukulitsa kwambiri kupezeka kwa njira zonse zopanda opioid zothetsera ululu wosatha

Pankhani ya ma opioid, kuthana ndi zomwe zimayambitsa kusuta kumafunikanso kuthana ndi chifukwa chomwe anthu ambiri adakumana ndi opioid poyamba - kupweteka kwakanthawi. Kutha kwa ma opioid kuphatikiza kuperewera kwa umboni wofufuza momwe zingathandizire kuthana ndi ululu wosatha, kumafunikira kuti gawo la yankho lake likhale pakupanga mankhwala ena opweteka kwambiri. Izi zidzafunika kusintha kosintha kwa ntchito zamankhwala ndi inshuwaransi.

Pafupifupi achikulire 50 miliyoni aku America ali ndi zowawa zazikulu kapena zopweteka kwambiri, malinga ndi National Institutes of Health's National Center for Complementary and Integrative Health (NCCIH). Kutengera ndi kafukufuku wa 2012 National Health Interview Survey (NHIS), kafukufukuyu akuti m'miyezi itatu yapitayi, achikulire aku 25 miliyoni aku US anali ndi zowawa zosatha tsiku ndi tsiku, ndipo 23 miliyoni enanso adamva kupweteka kwambiri. [6]

Pali njira zopanda opioid zothetsera ululu wosaneneka, kuphatikiza mankhwala osagwiritsa ntchito opioid, mankhwala apadera, kutambasula, ndi kuchita masewera olimbitsa thupi, njira zochiritsira zina ndi zina monga kuchiritsa, chiropractic, kutikita, hydrotherapy, yoga, chi kung, tai chi , ndi kusinkhasinkha. M'malo mwake, kwa nthawi yoyamba, American College of Physicians ikulangiza kuthana ndi kupweteka kwakumbuyo ndi mankhwala osokoneza bongo ngati awa asanagwiritse ntchito mankhwala owonjezera kapena othandizira. Kafukufuku waposachedwa wa Consumer Reports woyimira dziko lonse akuwonetsa kuti anthu ambiri omwe ali ndi ululu wammbuyo adapeza njira zochiritsira zina zothandiza. Kafukufuku wa akulu 3,562 adapeza kuti pafupifupi 90% ya omwe adayesa yoga kapena tai chi adanenanso kuti njirazi ndizothandiza; 84% ndi 83%, motsatana, adanenanso chimodzimodzi zokhudzana ndi kutikita minofu ndi chiropractic. [7]

Njira yopanda opioid yopweteketsa mtima imaphatikizaponso kuphunzira ndikuchita kusiyanitsa zowawa-chizindikiritso chomwe chimafalikira kudzera mu mitsempha yayikulu kuti "china chake chalakwika," kuchokera kuvutika-kutanthauzira kapena tanthauzo lomwe limaperekedwa ku chizindikiro chakumvulacho-chomwe chimalumikizidwa nacho . Kuvutika kumabwera chifukwa cha mayankho am'malingaliro ndi am'malingaliro kupweteka, ndipo kumaphatikizanso kuyankhula kwanu kwamkati ndi zikhulupiriro zomwe zimapangitsa zomwe zimakhudzidwa.

Njirazi zimafuna kuti anthu azitenga nawo mbali pantchito yawo yobwezeretsa ululu. Palibe aliyense mwa iwo amene ayenera kuchotsa kapena "kupha" kupweteka kwamunthu wina. Komabe, molumikizana ndikuchita bwino atha kupanga kusiyanasiyana kwakukulu pakumva kupweteka, kutha kudzilamulira, komanso moyo wonse.

Umwini wa 2017 Dan Mager, MSW

Wolemba wa Msonkhano Wina Umafunikira: Njira Yoyenera Yochotsera Kusuta Kwathu ndipo Mizu ndi Mapiko: Kulera Mwanzeru Pobwezeretsa (kubwera Julayi, 2018)

[2] https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

[3] http://paariusa.org/our-partners/

[4] https://www.cdc.gov/media/releases/2017/p-hepatitis-c-infections-tripled.html

[5] http://www.huffingtonpost.com/entry/with-opioid-crisis-a-surge-in-hepatitis-c_us_59a41ed5e4b0a62d0987b0c4?section=us_huffpost-partners

[6] Richard Nahin, "Chiwerengero cha Kupweteka Kukula ndi Kuopsa Kwa Akuluakulu: United States, 2012," The Journal of Pain, Ogasiti 2015 Vuto 16, Kutulutsa 8, Masamba 769-780 DOI: http://dx.doi.org /10.1016/j.jpain.2015.05.002

[7] http://www.consumerreports.org/back-pain/new-back-pain-guidelines/?EXTKEY=NH72N00H&utm_source=acxiom&utm_medium=email&utm_campaign=20170227_nsltr_healthalertfeb2017