Inkinga yesifo sobhadane ilokhu ingenye yezinselele ezinkulu zempilo yomphakathi e-United States, isho amashumi ezinkulungwane zokuphila unyaka ngamunye futhi icindezela izimiso zokunakekela impilo, imiphakathi, nemikhaya. Nakuba ukuthatha izinyathelo zikahulumeni zinikeza isiqondiso nezimali, izinhlu eziphambili zalesi sifo ngokuvamile zisesilinganisweni sikahulumeni. Izishaya-mthetho zisebenzisa amandla aphawulekayo okuhlela isimiso semithetho kanye nezimiso ezithinta ngokuqondile, ukwelapha, ukuphoqelela, nokulimaza. Eminyakeni eyishumi edlule, cishe wonke umbuso useke udwebe izindleko eziklanyelwe ukunqanda ukusetshenziswa kwe-opioids, ukungenela komsebenzi wokunakekela, futhi zibambe ukulandisa okungekho emthethweni. Le mizamo yokushaya umthetho ingenzekile, inamandla, futhi igxeka ukuguqula ukufa.

Ukufinyelela Kwemithetho Enhlekeleleni Ye - opioid

Izishaya-mthetho zikahulumeni ziye zathatha icebo elinemigomo eminingi lokusingatha umqedazwe we-opioid. Izindlela eziphumelela kakhulu zihlanganisa izinyathelo zempilo yomphakathi nezinguquko zobulungisa bobugebengu, ziqaphela ukuthi ukulutheka kuyisifo esiyinkimbinkimbi esidinga kokubili ukunakekelwa kozwela nomthetho oqinile. Izindawo eziyinhloko zokuthatha imithetho zihlanganisa ukwandisa amandla okwelashwa, ukunqanda ukugcinwa komthetho, nokufaka imali ekuvimbeleni. Indlela kahulumeni ngamunye ibonisa indlela yakhe eyingqayizivele yezombangazwe, izidingo zenani, kanye nobukhulu benkinga emingceleni yawo.

Ukwandisa Indlela Yokwelapha

Enye yezinsika ezibaluleke kakhulu zomthetho kahulumeni we-opioid ukukhuphula ukutholakala kwemithetho yokwelapha esekelwe kubufakazi, ikakhulukazi ukwelashwa okuhambisana nemithi (MAT). I-MAT ihlanganisa imithi evunyelwe i-FDA-avince, i-methadone, ne-naltrexone enezeluleko nokwelashwa kokuziphatha. Imibuso eminingi iye yadlulisela imithetho evimbela iziguli ukuba zingangeni kulolu kwelashwa olugcina ukuphila. Ngokwesibonelo, amazwe amaningana aye asusa izimfuneko zemvume zokusetshenziswa kwe-MEdicaid, anweba uhlu lweminyango engayala i-buplenorphine (kuhlanganisa asebe abancela abasiza abaguli nabasizi abasiza asebe), kanye nezingando ezandisiwe zezinhlelo zokwelapha.

Izwe futhi liye lafaka izakhiwo zezemisebenzi ye-telehealth ukuze lifinyelele emaphandleni nasemaphandleni angaphansi. Umqedazwe we-COVOVAD-19 uye washeshisa ukusetshenziswa kwe-telemedicine ukuze isetshenziswe ekuluthekeni, futhi izishaya-mthetho eziningi ziye zenza ukuba isikhashana sibe khona isikhashana. Imithetho manje ivumela iziguli ukuba zithole iziqondiso zokuthola izimpawu ze-odoctalnorphine ngokuhambela ngaphandle kokuhlola kokuqala. Lokhu kuye kwathinta kakhulu ezindaweni zasemaphandleni amakhulu, njengaseKentucky naseNtshona Virginia, lapho ukuswela kwezindawo zokuthutha nokunakekela impahla kuyisithiyo enkulu khona izithiyo.

Ngaphezu kwalokho, eminye imibuso iye yasungula izinkantolo zobuchwepheshe zokwelapha noma izinhlelo zokuqondisa izindiza eziye zaphambukisa izaphulamthetho ezingenabudlova ekwelashweni kunokuba ziboshwe. Lezinkantolo zivame ukuyala ukuba zihlanganyele eMATS futhi zinikeze ukunakekelwa kwezezimali ezinkulu. Imithetho iye yabela izimali zokwandisa amandla ezindawo zokwelapha, izikhungo zokuhlala, nezindawo zokwelapha ezisiza abaguli abakhubazekile. Ngokwesibonelo, iSishaya-mthetho saseOhio wadlulisela umthetho owethula umthetho owengakhomba ama-R342 000 ekwandiseni i-MP ekungeneni emajele asesifundazweni nasezindaweni zezempilo zomphakathi. Izimali ezinjalo zisiza igebethi yegumbi eliphakathi kwesidingo sokunakekelwa kwezisebenzi nesominyango.

Imikhuba Yokuyala

Ukugunyazwa ngokweqile kwama-opioid agunyaziwe kwakungumshayeli oyinhloko wezigaba zokuqala zalesi sifo. Ekuphenduleni, izishaya-mthetho zikahulumeni ziye zamisa imithetho ehlukahlukene yokukhuthaza ukumiswa kwemithetho engokomthetho. Ithuluzi elamukelwa kakhulu yi-Prectical Drug Monitoring Program (PDMP). Le mishini ye-electal trammap elawula imiyalo yemishosho elawulwayo futhi ivumela abayalengi nabathaka-mithi ukuba baqaphele iziguli eziba i-dokotela noma ukwamukela indinganiso eyingozi yezidakamizwa. Izikhulu eziningi manje ziyaleza ukuba abayaleza i-PDMP ngaphambi kokuba ikhiphe i-opioid yokwelapha izinhlungu, futhi ezinye zidinga ukuba zonke izinto ezilawulwayo. Ukuqinisa i-PDMPérobiergics kubaluleke kakhulu futhi kunezimo zikahulumeni, njengoba iziguli ezivame ukuthatha imingcele ukuze zithole imvume.

Ngalé kwe-PDMPs, izifunda eziningi ziye zabeka imingcele ekutholeni isilinganiso sobungakanani kanye nesikhathi sokunikezwa kwemiyalo yokuqala ye-opioid yobuhlungu obungathi sína. Ngokwesibonelo, izifunda eziningana zinikeza iziqondiso zesikhathi sokuqala ezithatha izinsuku eziyisikhombisa noma eziyishumi, nemithetho eqinile yezingane. Eminye imithetho ifuna ukuba iziqondiso zibhalwe ngesilinganiso esiphansi kakhulu futhi zihlanganise ingxoxo yezindlela ezingasetshenziswayo ezingezizodwa. Imfundo eqhubekayo engokwakheni inqubo yokulawula izinhlungu kanye ne-pioid inye imfuneko ejwayelekile kodokotela, amazinyo, nezinye iziqondiso. Imithetho embalwa iye yamisa ngisho nemithetho edinga ukuba iziguli zisayine imvume yokuvuma izingozi zokusebenzisa i-opioid ngaphambi kokuba zisebenzise i-othoid.

Ama-gistrature aye ahlela futhi ukugunyazwa eminyangweni yamazinyo ephuthumayo nasemikhankasweni yamazinyo, lapho ama-opioid evame ukubhalwa khona. Ngokwesibonelo, isifundazwe saseWashington samisa umthetho ngo-2021 owamisa iziqondiso zokubekwa kwangaphambi kwezimo eziphuthumayo, ekhuthaza ukusetshenziswa kwezidakamizwa ezingezona ze-athomiteria ezilwa nobuhlungu obungathi sína lapho kufanele. Lezi zinyathelo zokulawula ziye zanezela ukwehla okukhulu ezilinganisweni ze-opiopioid ezibekwa phambili ezimweni eziphuthumayo, nakuba izinselele zisalokhu zikhona ekuqinisekiseni ukuthi iziguli ezibuhlungu ezihlala njalo zisenakho ukufinyelela ukwelashwa okudingekile.

Ukuphoqelelwa Komthetho Nobulungisa Bobugebengu Kulinganiselwa

Nakuba ukuvimbela nokuphatha kusemqoka, ukugcinwa komthetho kuseyisici esibucayi somthetho kahulumeni we-opioid, ikakhulukazi ekulwisaneni nokushushumbisa i-fentanyl okungekho emthethweni nokubeka abathengisi bebanga eliphezulu icala. Izifundazwe eziningi zinesijeziso esengeziwe sokushushumbisa i-fentanyl kanye ne-alatosy, ngezinye izikhathi okunemijezo ephezulu edingwayo yokuba nenani elithile. Ezinye izishaya-mthetho ziye zakha futhi amacala amasha okungakazeli ekusakazeni i-carfentil, umdambisa-okisa-yoyela wezilwane onamandla oye watholakala empahleni yezidakamizwa ezingemthetho.

Ngesikhathi esifanayo, izifunda eziningi ziye zamukela izinguquko zomthetho zomthetho eziye zafaka kuqala ukuphathwa kweziboshwa zezomthetho zezidakamizwa ezisezingeni eliphansi. Izinkantolo zezidakamizwa, ezihlanganisa ukuphathwa komthetho nokuhlolwa kwemithetho ephoqelelwe nokuhlolwa kwezidakamizwa, ziye zanwetshwa ngezimali nangomthetho kahulumeni. Le zinhlelo ziye zaboniswa ukuthi zinciphisa ukuncishiswa kwemithetho futhi zonge imali yomkhokhi wentela. Ngaphezu kwalokho, imibuso eminingi iye yashaya imithetho elungile yamaSamariya enikeza ukuvikelwa ekuboshweni noma ukuquliswa kwabantu ababiza u-91111 ukuba babike ukusetshenziswa ngokweqile kwezidakamizwa. Lemithetho ikhuthaza izibukeli ukuba zifune usizo ngaphandle kokwesaba ukukhokha intela okungokomthetho, okungase kusindise ukuphila.

Imithetho yokungena ye-Naloxone iye yaba enye impumelelo enkulu yokuthola i-aspect. I-Naloxone (igama leNarcan) i-opioid antinagon engaguqula ukusetshenziswa ngokweqile uma isetshenziswa ngokushesha. Wonke amazwe manje anemithetho evumela okhemisi ukuba banikeze i-naloxone ngaphandle kwemvume, futhi amaningi andise ukufinyelela izimemezelo zokuqala zabapheli, izikole, nezinhlangano zomphakathi. Amanye afuna ukuba abaphathi-mthetho bathwale i-naxone, futhi amanye agunyaze ukuba noma ubani angayithenga ekhemisi. Ngokwesibonelo, i-Minnesopalse, idlulise umthetho ovumela ukuba umbuso ume ngemiyalo-e, izikole ze-naxone futhi wabela imali ukuba idluliselwe ukukhokhwana kwabantu abaphezulu. Le mizamo iye yandisa kakhulu ukutholakala kwale mithi yokusindisa ukuphila kwabantu.

Izinyathelo Zokuhlenga Eziyingozi

Eminyakeni yamuva, izishaya-mthetho zikahulumeni ziye zaphendukela kakhulu ekunciphiseni amasu okulimazayo njengendlela yomphakathi yokuvimbela impilo. Ukunciphisa izingozi kuhlela ukunciphisa imiphumela emibi yokusetshenziswa kwezidakamizwa ngaphandle kokufuna ukugwema. Ukusakaza iNaloxone kuyitshe eliseceleni, kodwa ezinye izinyathelo zihlanganisa izinhlelo zenkonzo ze-rin synthis (SSPSPs), i-fentyl i-millick, futhi isetshenziswa kabi emisha yokwelapha. Izinkonzo ze-Syrine zinikeza inaliti ezihluphayo kubantu abafaka izidakamizwa, ukunciphisa ukudluliselwa kwegciwane lesandulela nesibindi i-C. Ngemva kwamashumi eminyaka, inani elandayo lamazwe aye agunyaza i-SPSP futhi asebenzisa imali ukuze asebenze, eqaphela ukuthi athinta abahlanganyeli ngokulutha kwemiluthayo kanye nezinye izinkonzo zempilo. I-Kentuckeyson, ngokwesibonelo, uhlelo lwawo lwe-SPSP.

I-fentanyl i-operanyl yokuhlolwa isiyithuluzi elingcono ekuncishisweni kwezikhali. Lemitapo yokuhlola engabizi ivumela abantu ukuba bahlole ukuthi ikhona yini imithi yabo, exutshwa namaphilisi omgunyathi. Amanye amazwe aye alulaza ukuba nemicu yokuhlola futhi ayivumele ukuba idluliswe ngezinhlelo zezempilo zomphakathi. Kusukela ngo-2024, izifundazwe ezingaphezu kuka-30 ziye zakhipha imithetho ecacile yokususa imicu yokuhlola incazelo yezidakamizwa, zizenza zibe ngokomthetho ukuba zisebenzise futhi zibe nempahla yazo. Lento ebonakala ingathi ithatha isinyathelo esincane inganika abantu amandla okukhetha futhi bavimbele ukulahlekelwa okubulalayo.

Mhlawumbe ukuncishiswa kwengozi okuphikiswana kakhulu ukumiswa kwezikhungo zokuvimbela ukuphuza ngokweqile (okwaziwa nangokuthi ziyizikhungo eziqondiswa). Lezi zindawo zinikeza indawo ehlanzekile lapho abantu bengasebenzisa khona imithi enakekelwa ngaphambi kokuba isetshenziswe nezokwelapha, ukunciphisa ingozi yokubulawa ngokuningiliziwe nokudluliselwa kwezifo ezithathelwanayo. Nakuba kungekho mbuso oye wagunyaza izikhungo ezinjalo ngokomthetho njengo-2024, iRhode Island yaba eyokuqala ukugunyaza uhlelo lwezokushayela ngo-2021, neNew York City ngaphansi kwe-indulo yomnyango wezempilo wendawo. Izindawo zombuso eziningi ziphikisana ngokuqhubekayo nezihlongozo ezifanayo, ziqhutshwa ubufakazi obuvela kwamanye amazwe bokuthi lezi zinciphisa ukusetshenziswa nokuhanjelwa kwezindawo zomphakathi.

Izinyathelo Zokuvimbela Nemfundo

Izishaya-mthetho zikahulumeni ziye zaqaphela ukuthi intuthuko eqinile idinga ukuvimbela ukusetshenziswa kabi kwe-opioid ngaphambi kokuba iqale. Imizamo yokuvimbela ivame ukugxila emfundweni yentsha, ekuqeqesheni ukuqeqesha, nasemikhankasweni yokuqapha umphakathi. Amazwe amaningi manje agunyaza imfundo ye-opioid ezikoleni, ukufundisa abafundi ngezingozi zokusetshenziswa kabi kwemilaliso kadokotela nezingozi zefantanyl. Eminye imithetho ifuna ukuba uhlelo lwezifundo luhlanganise ukwaziswa ngempilo yengqondo, amakhono okubhekana nayo, kanye namasu lokuyenqaba. Ngokwesibonelo, i-Indianadinadian parsion, yakhipha isikhwama esifuna zonke izikole eziphakathi nephezulu ukuba zifake izivimbelelo zokuxhasha umphakathi ezisempilweni.

Imfundo yangaphambi kokubhaliswa iye yaba yinto ephambili futhi ibaluleke kakhulu. Ngaphandle kwezimfuneko zemfundo eziqhubekayo, eminye imibuso iye yamisa imithetho efuna izikole zokwelapha nezinhlelo zokuhlala ukuze ihlanganise ukuqeqeshwa kwe-opioid nokuqashwa kwangemva kwesikole. Ngaphezu kwalokho, imikhankaso yomphakathi wonke enikeza ukuqapha umphakathi ngemali yezindawo zokuhlala ze-opioid [1] ngokuvamile exhaswe ngemali ye-opioid ukuze inciphise ihlazo futhi ithuthukise imithombo yezokwelapha. Lemikhankaso isebenzisa imithombo yezokuxhumana, iziteshi, nezenzakalo zomphakathi ukuze ifinyelele abantu abahlukahlukene. Amassachusetts aqala umkhankaso asakaza ama-messachusethi ngo-adia ahlasela abantu abadala abaneminyaka engu-18235,35, egcizelela izingozi zamaphilisi mbumbulu nokutholakala kwe-axone.

Enye imingcele yokuvimbela ukulahlwa kwezidakamizwa okulondekile. Imithetho idluliselwe ukumisa izinhlelo ezihlala njalo zokuthatha izidakamizwa ezithathelwa emuva emaphaketheni, eziteshini zamaphoyisa, nasemisebenzini yomphakathi. Ezinye izifundazwe zidinga abenzi bemithi ukuba baxhase izinhlelo zokusetshenziswa kwemithi, futhi ezinye ziye zamisa umthetho okhuthaza ukusetshenziswa kwemikhiqizo elahlwa ekhaya. Ukulahlwa okufanelekile kunciphisa amathuba okuthi ama-opiopioid angasetshenziswangasetshenziswa. I-Oregon yakha inqubo yezidakamizwa esetshenziswayo ezindaweni ezisezweni lonke, yenza ukuba ibe ngenye yezithakazelo ezibanzi kakhulu ezizweni.

Izinselele Neziqondiso Zesikhathi Esizayo

Naphezu kwentuthuko ephawulekayo, izifunda zibhekene nezinselele eziphikelelayo ekusingatheni inkinga ye-opioid. I-Stigma ilokhu iyisithiyo esinamandla sokuziphatha okufuna ukwelashwa, kokubili kubantu abasebenzisa ukuphazamiseka kwezidakamizwa nakubaphathi bempilo abangase babe madolonzima ukugunyaza i-MAT. Ukuxhasa izindleko zokuthola izindleko zokuthatha izinyathelo, ngisho nanjengoba ama-opioid aqala ukukhuphuka ngenxa yokumangalelwa ezinkampanini ezithaka imithi.

I-opioid ingenye into ekhathaza kakhulu. Umqedazwe we-opioid uthinte ngokungenakulinganiswa imiphakathi yasemaphandleni, imiphakathi ethola imali encane, nabantu abathola imibala ephansi, kodwa ukukwazi ukwelashwa nokuncishiswa kwezinkonzo zomonakalo ngokuvamile kuhlala kugcwele ezindaweni zasedolobheni. Izishaya-mthetho zesizwe kumelwe zikhulume ngezinqanda-mpilo zezenhlalo, njengezindlu, umsebenzi, nokukwazi ukufinyelela ekunakekeleni okuyinhloko, ukudala izimo ezisekela ukululama. Ukusekela izinkonzo zempilo zengqondo nezokusetshenziswa kwemishoshoshoshoshovu esebenzise ukuphazamiseka kwemizwa nakho kubalulekile, njengoba abantu abaningi abanezifo zengqondo ezisebenzisa i-opioidyyy zinezimo ezikhona. Izimo eziningana ziye zadlula imithetho edinga ukukhomba imishuwa ukuze kuphele ukwelashwa ngengqondo nangokuluthayo ngokomzimba, kodwa ukugcinwa kusekhona.

Uma zibheka phambili, izishaya-mthetho zezwe ziyogxila ezimpikiswaneni eziningana ezivelayo. Ukwanda kwe-xylazine (ikhambi lezilwane) ekuthengisweni kwezidakamizwa ezingekho emthethweni kuye kwadala izinselele ezintsha, njengoba ingasabeli kuma-anoxone futhi ibangele amanxeba anzima. Amanye amazwe acabangela imithetho yokuhlola i-xylazine kanye nokunakekela amanxeba, kanye nokwandisa izijeziso zokusakaza kwayo. Ngaphezu kwalokho, ukuqaphela ochwepheshe bokusekela kontanga abanolwazi oluphilayo olunolwazi lokuluthwa yi - nandivid nolwazi oluqinile oluphilayo olubangelwa yi-incopedice, isitimela, isitimela, nezimali. Izizwe zingahlola futhi ukufinyelela kwezinga lokusebenza isikhathi eside okugunyaziwe, njengokuthuthukisa kwe-naxrepreexne ne-bon.

Ekugcineni, isidingo samasu agcwele, awenziwe ngokusemthethweni. Izifundazwe eziningi ziye zamisa amabutho noma amanxusa okuhlela imizamo yokuhlela izinhlangano futhi zitusa izinguquko zezimiso. Ukusetshenziswa kwemininingwane yangempela yokuhlola ukuvela kwezinsongo nemithombo yengcebo kuzoba okubaluleke kakhulu. Njengoba umqedazwe uqala, kanjalo umthetho wezwe kumelwe uthathelwe indawo ngaphezu kwezinyathelo zokuqala eziphuthumayo zokuvimbela, ukwelapha, ukuncipha, nokusekela kokululama.

Isiphetho

Ama-padmenmen ayizifekethisi ezibalulekile ekusabeleni enhlekeleleni ye-opioid. Ngenhlanganisela yokwanda kwendlela yokwelapha, imithetho yokugunyaza, izinguquko zomthetho, ukuncishiswa kwezinhlelo zokunciphisa ukukhubazeka, nezinhlelo zokuvimbela, baye basindisa ukuphila okungabalileki futhi banciphisa ukulawulwa komqeda walesifo. Nakuba kungekho nqubo eyodwa engaqeda inhlekelele, imiphumela eqhubekayo yobufakazi, umthetho osekelwe eqinile inamandla. Ukutshala izimali, ukusungula intuthuko, nokubambisana nezinhlelo zokuvimbela ukuthintela izingozi kuyo kuyoba okusha. Ngokufunda kuzo zombili impumelelo nokwehluleka, abamisi-mthetho bangaba nomthetho bangakha izakhiwo eziqinile zempilo ezingezona nje izintambo eziphonselelwe kodwa futhi zibeke isisekelo sesikhathi esizayo lapho ukulutheka kozwela nokwenziwa.

[[NTL: 0] Imithombo yezentengiselwano: Ukwaziswa okwengeziwe ngomthetho wezwe we-opioid, vakashela i-National Academy for State Health Policy ([FLT:]] i-National Academy for State Health Policy (NAFSP) opioid oractive comstorr[[[FLT:]]. Imininingwane nge-opioid ebulala ngokusetshenziswa kabi i-odrogen nezindlela zokuvimbela ukufa ikhona kuvela kumthetho [[[FLT:]]] izimboni zezokulawula i-DSP [[FLT] [FLT]] ezinikezwa imithombo yezelapha ngemithi yokwelapha (FLT]).[5]