Hanyar Mataki Guda Biyar zuwa Cutar Kwayar cuta, Sashi na 2 na 2

Dangane da Cibiyoyin Kula da Cututtuka da Cututtuka na Amurka (CDC), a cikin 2016, mutane 65,000 a Amurka sun mutu daga yawan shan miyagun kwayoyi - fiye da waɗanda aka kashe a Yaƙin Vietnam [1] - haɓaka kusan kashi 19 cikin ɗari akan mutuwar 54,786 rikodin shekarar da ta gabata kawai. [2] Mafi yawan waɗannan mutuwar da aka yi ta wuce gona da iri sun samo asali ne daga opioids.

A ranar 26 ga Oktoba, 2017, Shugaba Trump ya umarci Ma'aikatar Lafiya da Ayyukan Dan Adam ta Amurka da ta ayyana rikicin opioid na kasar a matsayin gaggawa na lafiyar jama'a a karkashin Dokar Ayyukan Kiwon Lafiyar Jama'a. Kamar yadda yake da mahimmanci kamar yadda wannan sanarwar take, ta gaza ba da izinin duk wani tallafin gwamnatin tarayya na gaggawa ko shimfida duk wasu dabaru na zahiri. Ya kuma saba wa alkawarin da Shugaban ya yi a watan Agusta na ayyana a gaggawa ta kasa a kan opioids, sunan da zai yi saurin raba kudaden tarayya. Bugu da ƙari, ya yi ɗan ambaton buƙatar faɗaɗa tsada na wadatar samun maganin jaraba wanda ke da mahimmanci don magance annobar.

Kada ku yi kuskure: babu harsasan sihiri kuma babu saurin gyara wannan rikicin. Koyaya, akwai matakai masu mahimmanci da yawa waɗanda za a iya ɗauka don rage lalacewar ta ga mutane, iyalai, da al'ummomi, da taimaka mana samun ci gaba mai ma'ana zuwa mafita.

1) Bayar da fifiko kan maganin jaraba akan kamawa da ɗaurin kurkuku

Daga cikin manyan matsalolin da ke ci gaba da yaɗuwar cutar ta opioid ita ce cewa yana da sauƙin ɗauka sama da yadda ake samun taimako. Soke Dokar Kulawa Mai Kyau (ACA, aka Obamacare) zai faɗaɗa wannan rata ne kawai, kawar da tallafin da Medicaid ya bayar na dubun dubatar mutanen da ke fama da jaraba. Sauran ƙoƙarin rage tallafin Medicaid zai yi tasiri iri ɗaya. Maimakon ci gaba da ƙoƙarin lalata ACA, kuɗin da ke sa maganin jaraba ya zama mai sauƙin buƙata ana buƙatar haɓaka, kuma ana buƙatar ƙarin jihohi don ƙarfafa yin amfani da fadada Medicaid na ACA.

Hukumomin tilasta bin doka a jihohi 30 yanzu sun shiga cikin shirin taimakawa 'yansanda da kuma shirin farfadowa (PARRI), wanda ke ba da magani ga masu amfani da miyagun ƙwayoyi waɗanda ke neman taimako daga hukumomin tilasta doka. [3] Maimakon mayar da hankali kan laifin da ke haifar da jaraba, ta hanyar PARRI, tilasta bin doka yana mai da hankali kan samun taimakon mutane da suke buƙata, ƙoƙarin da ba shi da ƙima kuma yana adana sakamako mai kyau fiye da kamawa (galibi ana maimaitawa) da ɗaurin kurkuku.

2) Taimakawa da faɗaɗa jiyya ta taimakon magunguna (MAT)

Ƙara bincike yana ba da shawarar cewa ɗayan ingantattun hanyoyin magance jarabar opioid shine ta hanyar maye gurbin magunguna ta amfani da methadone da buprenorphine. A matsayin wani bangare na tsarin da ke neman rage cutarwa maimakon dagewa kan cikakkiyar kauracewa, amfani da wadannan magunguna yana taimakawa rage raguwar koma baya da kuma matsalolin likitanci da ke da alaka da jaraba, haɓaka ikon mutane na yin aiki da sake gina rayuwarsu. Abin takaici, kawai wasu marasa lafiya na shirye -shiryen maganin jaraba a cikin Amurka a halin yanzu suna da wannan zaɓi.

MAT ba ta da koma baya, duk da haka. Methadone da buprenorphine su kansu opioids ne tare da damar su na jaraba - kodayake ɗan ƙaramin abu ne don buprenorphine, wani bangare (sabanin cikakken) agonist opioid. Da kyau, ana amfani da MAT azaman gadar da ke taimaka wa mutane sannu a hankali da ci gaba da kashe magungunan maye da sauyi zuwa kauracewa. Kamar yadda zai yiwu, yakamata ya zama mai iyakance lokaci maimakon tsarin maye gurbin rayuwa.

3) Ƙara samuwar naloxone

Masu amfani da opioid suna buƙatar ci gaba da rayuwa tsawon lokaci don neman magani. Kodayake yanzu an ba da izini a wasu jahohi da ƙara yawan gundumomi don ɗauka da gudanar da shi, masu ba da amsa na farko da ɗakunan gaggawa galibi ba su da isasshen wadatattun naloxone - maganin da ke magance yawan allurar opioid. Naloxone abokin adawa ne na opioid - ma'ana yana ɗaure ga masu karɓar opioid kuma yana iya juyar da tasirin opioids. Yana iya dawo da wani a rayuwa a zahiri, yana dawo da numfashi na al'ada ga mutanen da numfashinsu ya ragu sosai ko ya tsaya sakamakon yawan shan maganin opioids ko heroin. Hukumomin kiwon lafiya na tarayya da na jihohi suna buƙatar yin shawarwari kan farashi mai ƙanƙanta da ƙara faɗaɗa damar zuwa naloxone. Mai mahimmanci, har zuwa lokacin wannan rubutun, CVS yana ba da rahoton bayar da naloxone ba tare da takardar sayan magani ba a cikin jihohi 43 kuma Walgreens ya ba da sanarwar cewa zai samar da naloxone ba tare da izini ba a duk shagunan sa.

4) Fadada sauran albarkatun rage cutarwa

Gwamnati kuma tana buƙatar kashe ƙarin kuɗi akan musayar allura da tsaftace shirye -shiryen sirinji don yaƙar cututtukan da ke yaduwa ta hanyar raba allura. Haɓaka amfani da magungunan allura ta mutanen da suka canza daga opioids a cikin nau'in kwaya zuwa tabar heroin yana haifar da ƙaruwa mai girma a cikin cututtukan hepatitis C. Daga shekarar 2010 zuwa 2015, adadin sabbin cututtukan da suka kamu da cutar ciwon hanta C da aka ba CDC sun kusan ninki uku. [4] Hepatitis C a halin yanzu yana kashe mutane da yawa fiye da duk wata cutar da aka ruwaito zuwa CDC. Kusan Amurkawa 20,000 sun mutu daga cututtukan hepatitis C a cikin 2015, yawancin mutanen da shekarunsu suka kai 55 da haihuwa. Sababbin cututtukan ƙwayar cutar hanta C suna ƙaruwa cikin sauri a tsakanin matasa, tare da mafi yawan adadin sabbin cututtukan da aka ruwaito tsakanin masu shekaru 20 zuwa 29. [5]

5) Koyarwa da haɓaka faɗaɗa kasancewar duka, hanyoyin da ba su da opioid masu yawa don magance ciwo mai ɗorewa

Idan ya zo ga opioids, magance tushen abubuwan da ke haifar da jaraba shima zai buƙaci magance dalilin da ya sa mutane da yawa suka fallasa opioids da fari -ciwo na kullum. Hanyoyin jaraba na opioids a haɗe tare da ƙarancin shaidar tushen bincike game da ingancinsu a cikin magance ciwo mai ɗorewa, yana buƙatar cewa wani ɓangare na maganin ya ta'allaka ne wajen samar da madadin hanyoyin jin zafi da yawa. Wannan zai buƙaci canjin yanayi don sabis na kiwon lafiya da ɗaukar inshora.

Kusan kusan manya miliyan 50 na Amurka suna da matsanancin ciwo mai tsanani ko ciwo mai tsanani, a cewar Cibiyar Kula da Lafiya ta Ƙasa don Ƙari da Haɗin Kai (NCCIH). Dangane da bayanan da aka samu daga Binciken Tattaunawar Lafiya na Ƙasa na 2012 (NHIS), binciken ya kiyasta cewa a cikin watanni uku da suka gabata, manya miliyan 25 na Amurka suna fama da ciwon yau da kullun, kuma ƙarin miliyan 23 sun ba da rahoton matsanancin ciwo. [6]

Akwai zaɓuɓɓukan da ba su da opioid don magance ciwo mai ɗorewa, gami da magungunan da ba na opioid ba, ƙwarewar motsa jiki na musamman, shimfidawa, da motsa jiki na jiki, madadin magunguna masu dacewa kamar acupuncture, chiropractic, massage, hydrotherapy, yoga, chi kung, tai chi , da zuzzurfan tunani. A zahiri, a karon farko, Kwalejin Likitocin Amurka tana ba da shawarar magance ciwon baya tare da matakan nondrug kamar waɗannan kafin yin amfani da kan-kan-kan-counter ko masu rage zafin ciwo. Rahoton Masu Amfani na baya -bayan nan binciken wakilin ƙasa ya nuna mutane da yawa da ciwon baya sun sami madadin hanyoyin warkewa masu amfani. Binciken manya 3,562 ya gano cewa kusan kashi 90 na waɗanda suka gwada yoga ko tai chi sun ba da rahoton cewa waɗannan hanyoyin sun taimaka; Kashi 84 da kashi 83 cikin dari, bi da bi, sun ba da rahoto iri ɗaya dangane da tausa da chiropractic. [7]

Hanyar da ba ta da opioid ga ciwo mai ɗorewa kuma ya haɗa da koyo da yin aiki da rarrabe ciwo-siginar da ake watsawa ta cikin tsarin juyayi na tsakiya cewa "wani abu ba daidai ba ne," daga wahala-fassarar ko ma'anar da aka ba wannan siginar zafi-sau da yawa a haɗe da ita. . Sakamakon wahala yana haifar da martani na tunani da tausayawa ga jin zafi, kuma ya haɗa da magana ta kai da imani game da shi wanda ke haifar da halayen motsin rai.

Waɗannan hanyoyin suna buƙatar mutane su zama mahalarta masu aiki a cikin tsarin dawo da jin zafi. Babu ɗayansu da zai iya kawar ko “kashe” wani ciwo na yau da kullun. Koyaya, a haɗe kuma tare da yin aiki za su iya yin manyan bambance-bambance masu kyau a cikin gogewar jin zafi, ikon daidaita kai, da ingancin rayuwar gaba ɗaya.

Copyright 2017 Dan Mager, MSW

Marubucin Ana Bukatar Wasu Majalisar: Hanyar Daidaitawa don Maidowa daga Shaye -shaye kuma Tushen da Fuka -fukai: Hankali Mai Kulawa a Maidowa (yana zuwa Yuli, 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, "Ƙididdigar Raɗaɗɗen Ciwo da Tsanantawa a cikin Manya: Amurka, 2012," Jaridar Ciwo, Agusta 2015 Juzu'i na 16, Fitowa ta 8, Shafuka 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