Indlela Eyizinyathelo Eziyisihlanu Yobhubhane lwe-Opioid, Ingxenye 2 kwezingu-2

Ngokusho kwe-US Centers for Disease Control and Prevention (CDC), ngo-2016, bangu-65,000 abantu e-United States ababulawa ukweqisa izidakamizwa — abangaphezu kwalabo ababulawa empini yaseVietnam [1] —okukhuphuke cishe amaphesenti angu-19 ngaphezu kwabangu-54 786 ababulawa okurekhodwe ngonyaka owedlule. [2] Iningi lalaba bantu abafile ngokweqile libangelwe ama-opioid.

Ngo-Okthoba 26, 2017, uMongameli uTrump wayalela uMnyango Wezempilo kanye Nezinsizakalo Zabantu e-US ukuthi umemezele inkinga yezwe opioid njengesimo esiphuthumayo sezempilo yomphakathi ngaphansi koMthetho Wezinsizakalo Zezempilo Zomphakathi. Okubaluleke njengalesi simemezelo, kwehlulekile ukugunyaza noma yikuphi ukuxhaswa ngezimali okuphuthumayo noma ukubeka noma yimaphi amasu okhonkolo. Iphikise nesithembiso esenziwe nguMongameli ngo-Agasti sokumemezela a isimo esiphuthumayo sikazwelonke kuma-opioid, igama ebelizonciphisa ukwabiwa kwezimali zikahulumeni. Ngaphezu kwalokho, akazange akhulume kancane ngesidingo sokwanda okubizayo kokutholakala kwemithi yokulutha okubalulekile ekubhekaneni nalolu bhubhane.

Ungalenzi iphutha: azikho izinhlamvu zemilingo futhi akukho ukulungisa okusheshayo kule nkinga. Kodwa-ke, kunezinyathelo ezimbalwa ezibucayi ezingathathwa ukunciphisa ukulimala komuntu ngamunye, imindeni, kanye nemiphakathi, futhi kusisize senze inqubekelaphambili ebonakalayo ekutholeni izixazululo.

1) Beka phambili ukwelashwa kwezidakamizwa ngokuboshwa nokuboshwa

Phakathi kwezinkinga ezibaluleke kakhulu ezisekela ubhubhane lwe-opioid ukuthi kulula kakhulu ukukhuphuka kunokuthola usizo. Ukuphindaphinda i-Affordable Care Act (ACA, aka Obamacare) kuzokwandisa leli gebe kuphela, kuqede ukwelashwa okuxhaswa ngemali yiMedicaid amashumi ezinkulungwane zabantu abalwa nokulutha. Eminye imizamo yokunciphisa imali yeMedicaid izoba nomphumela ofanayo. Esikhundleni sokuqhubeka nokuzama ukubhubhisa i-ACA, imali eyenza ukwelashwa kwezidakamizwa ifinyeleleke kakhulu idinga ukwandiswa, futhi izifundazwe eziningi zidinga ukukhuthazwa ukwamukela ukunwetshwa kwe-Medicaid okutholakalayo kwe-ACA.

Ama-ejensi okuphoqelela umthetho ezifundazweni ezingama-30 manje abamba iqhaza kwi-Police Assisted Addiction and Recovery Initiative (PARRI), enikeza ukwelashwa kwabasebenzisa izidakamizwa abacela usizo kubaphathi bezomthetho. [3] Esikhundleni sokugxila ebulelesi obubangelwa ukulutheka, nge-PARRI, abomthetho bagxila ekutholeni abantu usizo abaludingayo, umzamo obiza kancane futhi uvikele imiphumela emihle ukwedlula ukuboshwa (okuphindaphindwa kaningi) nokuboshwa.

2) Ukusekela nokwandisa ukwelashwa okusizwa yimithi (MAT)

Ukwanda kocwaningo kusikisela ukuthi enye yezindlela eziphumelela kakhulu zokwelapha umlutha we-opioid ngokusebenzisa izindlela zokwelashwa ezishintshayo ezisebenzisa i-methadone ne-buprenorphine. Njengengxenye yendlela efuna ukunciphisa ukulimala kunokugcizelela ukuyeka ngokuphelele, ukusetshenziswa kwale mithi kusiza ekunciphiseni ukubuyela emuva kanye nezinkinga zezokwelapha ezihlobene nokulutha, kuthuthukisa amandla abantu okusebenza nokwakha kabusha izimpilo zabo. Ngeshwa, yidlanzana kuphela lezinhlelo zokwelashwa kwezidakamizwa e-US njengamanje elinenketho.

IMAT ayinawo ama-downsides ayo, noma kunjalo. I-Methadone ne-buprenorphine yizo zombili ama-opioid ezinamandla okuba umlutha — yize kunjalo kancane kwi-buprenorphine, i-agonist engaphelele (ngokungafani ne-opioid agonist ephelele). Ngokufanelekile, i-MAT isetshenziswa njengebhuloho elisiza abantu kancane kancane futhi bathuthuke kancane kancane emithini yokufaka esikhundleni nasekuguqukeleni ekugwemeni. Ngokusemandleni, kufanele kube nomkhawulo wesikhathi kunombuso wokufaka esikhundleni wokuphila isikhathi eside.

3) Khulisa ukutholakala kwe-naloxone

Abasebenzisi be-opioid badinga ukugcinwa bephila isikhathi eside ngokwanele ukuze bafune ukwelashwa. Yize manje sekugunyazwe kwezinye izifundazwe kanye nenani elikhulayo lomasipala ukuliphatha nokuliphatha, abaphenduli bokuqala namakamelo ezimo eziphuthumayo imvamisa abanazo izinto ezanele ze-naloxone — umuthi olwa nokudlula ngokweqile kwe-opioid. INaloxone ingumphikisi we-opioid-okusho ukuthi ibophezela kuma-opioid receptors futhi ingahlehlisa imiphumela yama-opioid. Ingabuyisa umuntu ngokoqobo, ibuyise ukuphefumula okujwayelekile kubantu abaphefumulelwe noma beyeke ngokumangazayo ngenxa yokweqa ngokweqile kuma-opioid kadokotela noma i-heroin. Ama-ejensi wezempilo kahulumeni nawombuso adinga ukuxoxisana ngamanani aphansi futhi aqhubeke nokwandisa ukufinyelela kwe-naloxone. Okubalulekile, njengesikhathi salokhu kubhalwa, i-CVS kubikwa ukuthi ihlinzeka i-naloxone ngaphandle kokuyalelwa yizifundazwe ezingama-43 kanti i-Walgreens isimemezele ukuthi izokwenza i-naloxone enganikezwa kadokotela kuzo zonke izitolo zayo.

4) Nweba ezinye izinsiza zokunciphisa ukulimala

Uhulumeni futhi udinga ukusebenzisa imali eningi ekushintshaneni ngezinaliti futhi ahlanze izinhlelo zesirinji ukulwa nezifo ezithathelwanayo ezisakazeka ngokwabelana ngezinaliti. Ukwanda kokusetshenziswa kwezidakamizwa zomjovo ngabantu abasuka kuma-opioid kwifomu lephilisi baya kwi-heroin kunciphisa ukwanda okukhulu kokutheleleka kwe-hepatitis C. Kusukela ngo-2010 kuya ku-2015, inani lokutheleleka ngegciwane le-hepatitis C elisha elibikwe kwi-CDC licishe laphindeka kathathu. [4] I-Hepatitis C njengamanje ibulala abantu abaningi ukwedlula noma yisiphi esinye isifo esithathelwanayo esibikwe kwi-CDC. Cishe abantu baseMelika abangama-20 000 babulawa yizimbangela ezihlobene nesifo sokusha kwesibindi kohlobo C ngo-2015, iningi labantu abaneminyaka engama-55 nangaphezulu. Ukutheleleka ngegciwane okusha kwesibindi kohlobo C kuyanda ngokushesha okukhulu phakathi kwabantu abasha, ngesibalo esikhulu kunazo zonke sokutheleleka okubikiwe kubantwana abaneminyaka engama-20 kuya kwengama-29. [5]

I-5) Fundisa futhi wandise kakhulu ukutholakala kwezindlela eziphelele, zama-opioid ezingenazinkinga zokubhekana nobuhlungu obungapheli

Uma kukhulunywa ngama-opioid, ukubhekana nezimbangela zomlutha kuzodinga futhi ukubhekana nesizathu sokuthi abantu abaningi bavezwa ama-opioid kwasekuqaleni — ubuhlungu obungapheli. Amandla okulutha ama-opioid ahambisana nokushoda kobufakazi obususelwa ocwaningweni bokusebenza kwabo ekwelapheni ubuhlungu obungapheli, kudinga ukuthi ingxenye yesisombululo ilele ekwenzeni ezinye izindlela zokwelapha izinhlungu zifinyeleleke kalula. Lokhu kuzodinga ukushintshwa kwepharadigm kwezinsizakalo zezempilo kanye nokutholakala komshuwalense.

Cishe abantu abadala baseMelika abangaba yizigidi ezingama-50 banezinhlungu ezinkulu ezingapheli noma ubuhlungu obukhulu, ngokusho kweNational Institutes of Health's National Center for Complementary and Integrative Health (NCCIH). Ngokuya ngemininingwane evela kuNhlolovo Kazwelonke Yezingxoxo Zempilo Kazwelonke ka-2012 (i-NHIS), lolu cwaningo lulinganisela ukuthi esikhathini esiyizinyanga ezintathu ezedlule, abantu abadala base-U.S abayizigidi ezingama-25 babenezinhlungu ezingamahlalakhona zansuku zonke, kanti abanye abayizigidi ezingama-23 babika ubuhlungu obukhulu. [6]

Kunezinketho zamahhala zama-opioid zokubhekana nobuhlungu obungapheli, kufaka phakathi imishanguzo engeyona i-opioid, ukwelashwa okukhethekile ngokomzimba, ukunweba, nokuzivocavoca umzimba, izindlela zokwelapha ezihlukile futhi ezihambisanayo njenge-acupuncture, i-chiropractic, i-massage, i-hydrotherapy, i-yoga, i-chi kung, i-tai chi , nokuzindla. Eqinisweni, ngokokuqala ngqá, i-American College of Physicians yeluleka ukwelapha ubuhlungu beqolo ngezindlela ezingezona zokusebenzisa izidakamizwa ngaphambi kokusebenzisa imishanguzo etholakala ekhawunteni noma yokunciphisa ubuhlungu. Ucwaningo lwamuva nje lwabathengi lubonisa ukuthi abantu abaningi abanezinhlungu zasemuva bathole ukuthi ezinye izindlela zokwelapha ziwusizo. Ukuhlolwa kwabantu abadala abangu-3,562 kwathola ukuthi cishe amaphesenti angama-90 alabo abazama i-yoga noma i-tai chi babika ukuthi lezi zindlela zazisiza; Amaphesenti angama-84 namaphesenti angama-83, ngokulandelana, abike okufanayo maqondana nokubhucungwa kanye ne-chiropractic. [7]

Indlela engenazo i-opioid ebuhlungwini obungapheli ibandakanya ukufunda nokwenza umkhuba wokuhlukanisa izinhlungu — isignali edluliswa ngohlelo oluphambili lwezinzwa ukuthi “kukhona okungahambi kahle,” kusuka ekuhluphekeni — incazelo noma incazelo enikezwe leso siginali sobuhlungu — esivame ukunamathiselwa kuso . Ukuhlupheka kubangelwa izimpendulo ezingokwengqondo nezingokomzwelo ebuhlungwini, futhi kufaka phakathi ukuzikhulumela kwangaphakathi nezinkolelo ngakho okudala ukusabela okungokomzwelo.

Lezi zindlela zidinga ukuthi abantu babe ngabahlanganyeli abakhuthele kakhulu enqubweni yabo yokululama kobuhlungu. Akekho kubo ongaqeda noma "abulale" ubuhlungu obungapheli bomuntu. Kodwa-ke, ngokuhlangana nangokuzijwayeza bangenza umehluko omkhulu omuhle ekuhlangenwe nakho okuzithobayo kobuhlungu, amandla okuzilawula, kanye nekhwalithi yonke yempilo.

Imininingwane 2017 Dan Mager, MSW

Umbhali we Omunye Umhlangano Uyadingeka: Indlela Elinganiselayo Yokuthola Ukubuyiswa Emlonyeni futhi Izimpande Namaphiko: Ukukhulisa Umqondo Ngokutakula (eza ngoJulayi, 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] URichard Nahin, "Izilinganiso Zokusabalala Kwezinhlungu Nobunzima Kubantu Abadala: I-United States, 2012," I-Journal of Pain, Agasti 2015 Umqulu 16, Issue 8, Amakhasi 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