Inkinga Ye - opioid Nendima Ephakeme Yabaphathi BoMbuso

Iopioid ilokhu ingenye yezimo eziphuthuma kakhulu zempilo yomphakathi ezibhubhisa kakhulu emlandweni wanamuhla waseMelika, isho amashumi ezinkulungwane zokuphila minyaka yonke futhi icindezela izimiso zokunakekela impilo, ukugcinwa komthetho, nemiphakathi. Nakuba izinhlangano zikahulumeni zinikeza iziqondiso ezixhasayo, izintambo eziphambili zokusabela zilawulwa ohulumeni bezwe. Izikhulu zikahulumeni (/izikhulu zezwe), ababusi, abameli, abameli jikelele, kanye nezikhulu zempilo ezilawula igunya elibalulekile lokuhlela izimiso ezithinta ngokuqondile ukugunyazwa kwemithetho, ukwelashwa okungalawuleki, ukukhubazeka, ukukhubazeka, ukuviswa kwemizwa kwemithetho. Izinqumo zabo zinquma indlela imithombo ephumelela ngayo, indlela imithetho ebhalwe ngayo, futhi iphoqelelwe ngayo, futhi indlela abaqondisi-mfakele ngayo labo abadinga ubufakazi ngokushesha.

Lesi sihloko sihlola indima ebalulekile efezwa abaphathi bakahulumeni ekusingatheni inhlekelele ye-opioid, amasu ayinhloko abawasebenzisayo, izithiyo, nezibonelo zangempela zezwe zezindlela ezihamba phambili eziphumelelayo zikahulumeni. Ngokuqonda lamandla anamandla, abasekeli beminyango bangasekela kangcono futhi basebenzise izimiso ezisindisa ukuphila futhi zinciphise imiphumela emide yomqedazwe.

Indima Yabaqondisi Bombuso Ekulwisaneni Nomqedazwe We - opioid

Izikhulu zikahulumeni zinezikhundla ezikhethekile zokuhlanganisa ukusabela okuhlukahlukene okuhlanganisa amahhovisi ezempilo, ama-Medicaid, izinqubo zokwelapha eziphazamisayo, izinhlangano zomthetho ezilawula imithetho nezimiso zemfundo. Zibeka indlela yokuthi amazwe azo angene kanjani ekuluthekeni − noma enjani njengendaba yomthetho wezobulungisa, inselele yempilo yomphakathi, noma inhlanganisela yazo zombili. Iziqondiso zabo, izihlongozo zemali, nezinhlelo zomthetho zingasheshisa noma zivimbele ukusebenzisa amasu aqinisekisi aqinisekisiwe.

Ngokwesibonelo, ababusi banamandla okumemezela isimo esiphuthumayo sempilo yomphakathi, esingavula iziphakamiso ezivumelanayo ezisekelayo nokukhipha iziphakamiso ezilawulayo. Bangamisa futhi amabutho omsebenzi, baqondise amanxusa kahulumeni ukuba ahlele ukusakaza i-anoxene, futhi baxoxe nezempilo nezinshuwa-mfunda-mfunda-mzansone ukuze basuse izithiyo zokwelapha (IMP). Ama-athorney alawula izinyathelo zokuhlola imilaliso yemithi (PDMP). Ngenkathi efanayo, ngokuvamile, ahola izitejikishiname ngokumelene nabenzi bemithi ethaka imithi kanye nabashicishishi, andisa izigidi zezigidi zezigidi zezigidi zezigidi zemali ezingaxhasa izinhlelo zokuthola ukulutha kwemizwa. Izikhulu zezwe zezombuso zezomthetho zokuhlola imilaliso (PMPs) kanye nemininingwane ye-odrogiontivey.

Ngoba i - opioid ishintsha ngokushesha — kusukela kuma - opioid agunyaziwe kuya ku-heroin kuya ku-fentanyl futhi manje kuya ku-xylazine allerants . Izikhulu zezwe kumelwe zivumelane njalo nendlela eziyisebenzisa ngayo. Ukuhola kwazo kubalulekile ukuze zilondoloze amandla nokuqinisekisa ukuthi izimiso ziyaqhubeka zivumelana nobufakazi bamuva nezinsongo ezivelayo.

Izinyathelo Eziyinhloko Ezisetshenziswa Abaholi BoMbuso

Izikhulu zikahulumeni ziye zasebenzisa izindlela eziningi zokunciphisa ukusetshenziswa kabi kwe - opioid, ukuvimbela ukusetshenziswa ngokweqile kwezidakamizwa, nokwandisa amathuba okunakekelwa. Nakuba kungekho nhlobo indlela yokuzisiza ekwenza ungabi namuntu ozothile, lezi zindawo ezilandelayo ziye zabonakala zinamandla amakhulu.

Ukwandisa Indlela Yokwelapha Nokululama Okubangelwa Imithi

Elinye lamathuluzi aphumelela kakhulu okulwa nokuphazamiseka kokusebenzisa i-opioid (OUD) ukwelashwa okuhambisana nemithi. Izifunda-zwe eziningi ziye zandisa i-Medicaid ngaphansi kwe-Affordable Care Act, zinikeza imvume yokukhokha ukuluthwa kokusebenzisa i-afrenorphine. Ucwaningo lubonisa ukuthi i-Medicaid yandisa izinga lezimali lokusebenzisa imitholampilo ephansi ngokuthuthukisa izimali ze-Médicaid, nokusekela amaqoqo okwelapha nge-mouse.

Abaqondisi bezwe baye basebenza futhi ukususa izithiyo ezilawulayo. Ngokwesibonelo, abanye baye bavala imfuneko ye-raveter ehlukile ukuze bagunyaze i-buprenorphine (i- "X-waiserr"), isinyathelo kamuva esiboniswa umthetho kahulumeni. Abanye baye bafaka imali ezinkonzweni ze-telehealth, ukuvumela iziguli ezihlala emaphandleni ukuba zingene kude nochwepheshe abaluthayo. Ngaphezu kwalokho, amajaji aye asekela "hub-ray-pagn" izikhundla ezikhethekile zokwelapha ukulutha (i-hubs) ezihlangene namasheshishishi (i) okunakekela okuyinhloko.

Ukusebenzisa Izinhlelo Zokuhlobisa Ngezidakamizwa Ezigunyaziwe (Izinombolo Zokuxhumana)

Ama-PDMP ayizinto zokuxhumana ezisezingeni eliphezulu zikagesi ezilandelana nokusetshenziswa kwemiyalo elawulwayo. Uma zisetshenziswa ngokuphumelelayo, zisiza odokotela ukuba baphawule iziguli okungenzeka zisebenza ngokuzilungisa noma ukuthola ingxube eyingozi yama-opioid nama-benzodiazepines. Izikhulu zikahulumeni ziye zaqinisa ama-PDMP ngemibuzo e-ocessing, ukuhlanganisa ukwaziswa namarekhodi empilo kagesi, nokwenza izimiso ezisebenza ngokuvumelana nemigqa kadokotela. Ezinye izifundazwe ziye zadinga ukuba ama-PDMP ahlolwe ngaphambi kokuba kufakwe ama-opieoid ezinhlunguvuzo zobuhlungu (umz. ngemva kwemicimbi) ukunciphisa izingozi zokusetshenziswa kabi kwamazinyo.

Abaqondisi bezwe abatholakali baye basebenzisa futhi ukwaziswa kwe-PDMP ukuze babheke izijeziso ze-trisk ephezulu, bathumele imibiko ye-oparence, futhi baphawule imiphakathi enezilinganiso ezingaphezulu ezigunyazwe ukungenela kwe-avegegeoid. Nokho, izinselele zisalokhu zikhona ekuqinisekiseni ukuthi ama-PDMP anobungane, aphezulu kakhulu, futhi awawona umthwalo onzima kakhulu kodokotela bemithola-mtholampilo.

Ukusekela Izinyathelo Zokulungisa Ingozi

Amasu okunciphisa umonakalo aye athola ukwamukelwa ngokukhula njengengxenye ebucayi yokusabela kwe-opioid. Izikhulu zikahulumeni ziye zafeza indima enkulu ekwandiseni ukufinyelela i-naloxone, umuthi osindisa ukuphila oguqula ukusetshenziswa kokusebenzisa i-opioids. Abaningi baye bakhipha amaoda aqinile avumela ama-pharmacy ukuba akhiphe i-naloxone ngaphandle komthetho, izinhlelo zokusakaza ezisekelwe emphakathi, kanye nabalahliwe kuqala abasebenzi basekhaya abaqeqeshelwe ukusetshenziswa kwayo.

Ezinye izifundazwe ziye zaqhubekela phambili ngokumisa izinhlelo ze-spps zomjovo (SSPS), ezinikeza imishini ekhipha imijovo ekhipha igciwane lesandulela ngculaza nesibindi sokusha kwesibindi, futhi zinikeza amathuba okuxhumanisa abantu nokwelashwa. Izifunda ezimbalwa nazo ziye zaqondisa izindawo zokusetshenziswa kwemijovo eziqondiswe, lapho abantu bengasebenzisa khona imithi ngaphansi kokuqondisa kwezokwelapha ukuze bavimbele ukusetshenziswa okubulalayo. Nakuba lezi zinyathelo zihlala ziphikisana kwezombangazwe, izikhulu zikahulumeni ezindaweni ezinjengeRhode Island, New York, neCalifornia ziye zawaphoqelela phambili njengezindlela zempilo yomphakathi ezisekelwe ezindaweni ezisekelayo.

Izinguquko Ezingokomthetho Nobulungisa Besigebengu Buyasondela

Abaphathi bezwe bathonya umthetho ongase uphinde ushicilele indlela amacala ahlobene nalesi simo aqulwa ngayo nayindlela abantu abaluthwe ngayo phakathi kwesimiso somthetho womthetho wobugebengu. Ababusi abambalwa baye basayina imithetho ethi "Muhle Samariya" enikeza ukugonyelwa okulinganiselwe kokuqulwa kwamacala abantu ababiza u-911 ngesikhathi besebenzisa isilinganiso esingaphezulu kakhulu. Abanye baye basekela izinhlelo eziye zaphambukisa izakhamuzi zezidakamizwa ezisezingeni eliphansi ukuba ziphathwe esikhundleni sokufakwa ejele.

Ngaphezu kwalokho, izikhulu zikahulumeni ziye zasebenzela ukulungisa ukubekwa kwemithetho, njengokulinganisela isikhathi nesilinganiso semiyalo yokuqala ye-opioid yezinhlungu ezinkulu. Izifundazwe eziningi manje zidinga abayali ukuba banikeze ezinye izindlela zokulawula ubuhlungu futhi baxoxe ngezingozi neziguli. Ngesikhathi esifanayo, abameli abaphethe izakhiwo ezisemthethweni eziwuphawu lwezigelekeqe, kuhlanganise nezindawo eziyizigidi eziyizinkulungwane ezingu - R2,2 ezihlala u-opioid kanye no-Johnson & Johnson kanye nabaxopiers, ezinikeza izimali zezinkonzo zokulutha.

Izinselele Ezibhekene Nabaphathi Bombuso

Naphezu kwemizamo yabo engcono kakhulu, abaholi bombuso babhekana nezinselele ezinkulu ezenza ukulwa nenhlekelele ye - opioid kube nzima.

Ukulinganiselwa Nokungabikezeli Ukusetshenziswa Kwemali

Inkokhelo enkulu yokusekela ukusabela kwe-opioid ivela ezinkokhelweni zikahulumeni, njenge-State Opioid Response (SOR) enikezwa yi-SAMHSA. Nokho, lezi zibonelelo zivame ukulinganiselwa isikhathi futhi zihlotshaniswa nesigaba sezombangazwe. Izikhulu zikahulumeni futhi kufanele zincintisane nezinye izinto eziza kuqala zemali , ukuqeqesha, izisekelo zempilo, zenza kube nzima ukusekela izinhlelo zokuvimbela isikhashana nezokuphatha. I-opioyoid fakin, kanti ivame ukususwa ngeminyaka eminingi futhi ingafika ngemingcele engathi ingathunyelwa ngokushesha.

Ukuvilapha Nokuphikiswa Kwezombangazwe

Ukulutheka kuhlala kululaza kakhulu, futhi izikhulu eziningi zikahulumeni zibhekene nokwehluleka lapho ziveza ukuncishiswa kwezinyathelo ezilimazayo ezinjenge-SPS noma izindawo zokusetshenziswa kwemishini eziqondiswayo. Ukuphikisa kwezindawo zendawo, ukugcinwa komthetho, kanye nokusetshenziswa kwemithetho okungalawuleki kungavimbela noma kubambezele. Ngisho nokwanda kobufakazi obusekelwe ekulashweni kungase kubhekwe njengokuthiwa "ukugembula" ukusetshenziswa kwezidakamizwa ngezigaba zomphakathi, kuphoqelele abaholi bamazwe ukuba bafake imali eningi emikhankasweni yemfundo yomphakathi.

Ukulinganisela Impilo Yomphakathi Nomthetho

Izikhulu zikahulumeni kumelwe zilawule umbango phakathi kokwelapha ukulutheka njengendaba yezempilo nokunqanda ukutholakala kwezidakamizwa ezingekho emthethweni. Ukuthatha izinqubo zokujezisa ngokweqile kungavimbela abantu ukuba bafune usizo, kuyilapho izimiso zokuyekelela zingabhekwa njengezingaphumeleli kakhulu kubashushumbisi. Ukuthola ukulinganisela okulungile kunzima, ikakhulukazi ezizweni ezinemithombo elinganiselwe yemali kanye nezinga eliphakeme lobugebengu obunobudlova obuhlobene nezimakethe zezidakamizwa.

Ukuhlanganyela Imininingwane Nokubambisana

Isimiso se-opioid esisebenzayo sincike ekwazisweni okuqondile, okufike ngesikhathi. Nokho, iminyango yezempilo kahulumeni, amanxusa e-Medicaid, izinhlelo ze-PDMP, kanye nokugcinwa komthetho ngokuvamile kusebenza e-silos nezindawo zokuxhumana ezingavumelani. Imithetho yangasese njenge-HIPAA ingavimbela futhi ukuhlanganisa ulwazi. Izikhulu zikahulumeni zidinga ukutshala imali ezingxoxweni zempilo kanye nasekuxhumaneni kolwazi lwezimo ezilandelanayo futhi zibone izingozi eziqhamukayo (umz., izikhomba ezisebeni zokufa kwe-fentanyl).

Amadolobha Namadolobha Ahlukene

Inkinga ye-opioid ithinta kokubili imiphakathi yasemadolobheni nasemaphandleni, kodwa izinselele ziyahluka. Izindawo zasemaphandleni ngokuvamile azinazo izikhungo zokuluthwa utshwala, izinkonzo ezilimazayo, kanye nezinto zokuhamba zomphakathi eziya ezindaweni eziqashweni. Izindawo zasemadolobheni zibhekene nokunqwabelana okukhulu kwefentanyl nezidakamizwa zokwenziwa, kanye nokungabi namakhaya amaningi kanye nokugula kwengqondo okungalawuleki. Izikhulu zikahulumeni kumelwe zivumelane nezimiso ezihlukene − inqubo eyodwa yemali engcono kakhulu esebenzayo.

Ukunqoba Izinselele Ngokuqala Nokukhandleka

Naphezu kwalezi zithiyo, izikhulu eziningi zikahulumeni ziye zabonisa ikhono lokusungula nokuzimisela okuphawulekayo. Ziye zakha izikhomba zemisebenzi engcono kakhulu ukuze zihlanganyele, zisebenzisane nenzuzo enjenge-National Guvernals Association opioid, futhi zihileleke ngokuqondile emiphakathini ethintelwe ukulutheka. Abanye baye bamisa "opidoid comments" ukuhlanganisa ukusabela ezinhlanganweni futhi baqinisekise ukuthi imali isetshenziswa ngokuphumelelayo.

Ubuchwepheshe bunikeza nezindlela ezintsha. Izifunda eziningi zisebenzisa umshini ukuze zibikezele ukuthi zisebenzisa amachashaza ashisayo ashisiwe kakhulu kanye nokusakazwa kwe-naloxone. Ezinye zithumele ama-apps axhumanisa abantu nezindawo zokwelapha ngesikhathi sangempela. Izikhulu zikahulumeni ezimukela lezo zinguquko zingafinyelela imiphumela engcono ngemithombo elinganiselwe.

Ukuhlola Icala: Izinyathelo Eziphumelelayo ZoMbuso

Ukuhlola izifunda ezithile kunikeza izifundo eziwusizo zemisebenzi − kanye nento engasebenzi(in opioid).

UOhio: Ukusabela Okuyikho konke, Ukusabela Kwemininingwane

I-Ohio ibilokhu ikhona ekwakheni kwenhlekelele ye-opioid, enamanani okufa aphindwe kakhulu phakathi kwezwe. Ekuphenduleni, uMbusi uMike DeWine wasungula "U-Ohio Opioid Refection" ngo-2019, ehlanganisa i-R9, 000 000 yezigidi zemali kahulumeni ekhona kuhulumeni. Izinyathelo eziyinhloko zihlanganisa ukufinyelela ezindaweni eziphuthumayo eminyangweni ephuthumayo, ukuxhasa imishini yempilo efinyelela emaphandleni asemaphandleni e-Apalca, futhi yenza i-opioid Flacketry" yokubulala imikhondo, amayadi, kanye nemisebenzi yokwelapha. Isifundazwe esibekwe kakhulu ekwabiweni se-naxone nomthetho sikhokhwaswe ukukhomba abantu ngabanye endaweni yejele. Ngokomphumela, ukufa kwe-Ohiokie, kwancipha ngo-4% ngo-20%, nango-20222%, ngokwenye i-tempostation, ngokwemininingwane enzile ye-202.

IRhode Island: Ukufuduka Okulimazayo

Rhode Island uye wathatha indlela yokubhekana ngesibindi ngokuhlanganisa ukuncishiswa kwengozi esimisweni sayo esivamile sempilo. Ngaphansi koMbusi uGina Rainondo futhi kamuva uMbusi uDan McKee, isifundazwe saxhasa umshayeli wesiza eholidi we-injini ye-Rhode (esokuqala) ezweni) futhi sandisa izinhlelo zayo zenkonzo ye-jognothyl ukuze hlanganise izicubu zokuhlola nokunakekela izilonda. IRhode Island yasebenzisa futhi indlela yokwelapha eyandisa ngokuphawulekayo inani labantu abamukela i-MPET. Ngo-2023, umbuso wabika ukwehla kweshumi nambili% ekunciphekeni kwenani eliphakathi kokusebenzisa i-omijovotel kanye nokunakekela izilonda. IRhode Island yasebenzisa futhi indlela yokwelapha eyandisa inani elingaphezulu kakhulu ngonyaka ongaphambili.

INtshonalanga Virginia: Ukuqeda Izithiyo Zasemaphandleni

I-West Virginia inenani eliphakeme kakhulu lokufa kwabantu abasebenzisa iopioid engaphezulu kakhulu ezweni, kodwa izikhulu zikahulumeni ziye zathatha izinyathelo ezinzima zokuthintana nezindawo zokungena emaphandleni. UMbusi uJim Justice wandisa uhlelo lwe-Medicaid ukuze ahlanganise i-MTHET futhi wasebenzisa uhulumeni ukunikeza imali ukuze wakhe amaqembu aphendulayo avakashela abasinda abasebenzisa kakhulu amakhaya abo. Izwe laqala futhi iqonga elixhumanisa izakhamuzi zasemaphandleni nochwepheshe bemiluthamo eWest Virginia University. Nakuba izinselele ziqhubeka, lezi zisiza ekunciphiseni amanani abantu abafayo kanye nokwanda kokuthola izindleko ngeminyaka engu-15%.

Iziqondiso Zesikhathi Esizayo Zesenzo Sokuqondisa Uhulumeni

Inkinga ye-opioid iyaqhubeka ivela, ngokukhula kwamaphilisi omgunyathi efentanyl anemibhobho exutshwe nefentanyl, i-xylazine (isilwane esidambisa izinhlungu), kanye nokusetshenziswa kwe-polypulanting. Abaphathi bezwe kumelwe baqhubeke ngaphambi kwalezi zimo. Izinto eziza kuqala esikhathini esizayo kufanele zihlanganise:

  • [ Ifaka ezimisweni zesikhathi sangempela sokuqapha [ engabona izinto ezivelayo futhi ichumise izixwayiso zempilo yomphakathi.
  • Ukuhlela ukulawulwa kokulawula ukuvumelana (ukwelashwa okusekelwe kunyakazo) ukuze kuqabuliswe futhi kuxhaswe ukucwaninga okubonisa ukuphumelela kwayo.
  • Ukwandisa izisebenzi eziyimilutha ngokuqeqesha ngezimali ochwepheshe bokwelapha kontanga, odokotela abancelisayo, kanye nabasizi bodokotela ukuba bagunyaze i-MAT.
  • Ukuhlola kwembulunga yonke ukusebenzisa ukuphazamiseka kwemithi ekunakekeleni okuyinhloko, eminyango yesimo esiphuthumayo, kanye nemithola-mpilo yangaphambi kokubeletha.
  • ukubambisana okuqinisayo kwesifundazwe ekuhloleni okugunyaziwe kanye nakugunyaza ukugcinwa komthetho okuhlangene ekuphazamiseni ukushushumbiswa kwezidakamizwa.

Ohulumeni namaqembu abo kufanele baqhubeke bethatha izikhundla ezingokomthetho ukuze bakhe imifudlana enikezelwe, ethatha isikhathi eside ukuze ithole izinkonzo zokulutheka − ukunqanda imali ukuba ingaphambukiselwa ekusebenziseni imali. Imikhankaso yemfundo yomphakathi eyenza abantu babe yimilutha futhi inciphise ihlazo ibalulekile ukuze kwakhiwe ukusekela komphakathi okubanzi.

Isiphetho

Izikhulu zikahulumeni yizimpikiswano ze-linchpins zaseMelika. Igunya labo ezinhlanganweni zempilo, ezibhalisayo, ezibhalisweyo, kanye nomthetho libanika ikhono eliyingqayizivele lokuguqula ubufakazi, ukusindisa ukuphila, nokunciphisa umonakalo wezenhlalo nowezomnotho obangelwa yimilutha yezezimali. Nakuba izinselele ezinjengokulahlekelwa imali, ihlazo, nokuphikisa kwezombangazwe ziphikelela, ukusungula nokuzimisela ukuhola okuboniswe ezizweni ezinjenge-Ohio, iRhode Island, neNtshona Virginia zibonisa ukuthi intuthuko ingenzeka.

Njengoba lomqedazwe uqhubeka uphenduka, isibopho esiqhubekayo esivela kubaphathi bakahulumeni − ukubambisana nobudlelwane nezinhlangano zikahulumeni, imiphakathi, kanye nabanakekela impilo bendawo (_nendlela yokunakekela) kuyoba okubalulekile. Umgomo awukona ukunciphisa nje ukufa kwabantu okusetshenziswa ngokweqile, kodwa ukwakha isimiso esibanzi, esinesihawu, nesiqinile esivimbela ukulutheka nokusekela ukululama kwabo bonke abantu baseMelika.

Ukuze uthole ukwaziswa okwengeziwe, bheka CD's National Drug Overdose Surveillance, umbusi wesizwe we-Opioid Anitive[, kanye [[FLT:]] nokulandelana kwezimali zezwe zemali ye-opioid .