RESUMO
Many Americans with opioid use disorder (OUD), do not have access to treatment. Mobile narcotic treatment programs are now under new regulations that may make treatment more accessible to more people. These mobile programs can help expand the reach of opioid agonist treatment for OUD, help reduce human immunodeficiency viruses (HIV) and hepatitis C in the OUD population, and have retention rates that are often better than those at fixed-site clinics. Mobile services can also help reach marginalized individuals, the homeless, rural communities, and other underserved communities. They may offer methadone or buprenorphine treatment. Such mobile services have been used inside and outside the United States with promising results. In particular, mobile programs can make treatment available to people who do not have insurance, who lack reliable transportation, live in chaotic situations, or may be undomiciled. The potential pairing of mobile programs together with technology, such as smartphone apps or online resources, may allow mobile patients to benefit from counseling as well. Mobile clinics must be attached to a fixed-site narcotic treatment program and may have limitations with respect to the geographic area served. Mobile programs must have policies and procedures to store, transport, deliver, account for, reconcile, and dispose of opioid waste and would be subject to audit. Mobile opioid agonist therapy is an important and innovative service of particular value to underserved communities.
RESUMO
Hospitals, clinics, and organizations using controlled substances must have policies and procedures in place for disposing of these substances and to avoid potential drug diversion as well as environmental pollution. Challenging, particularly to hospitals, is the ability to dispose of the waste of any number of hundreds of products every day, some of which require specific handling and protocols for safety. Incineration might be appropriate but many hospitals and certainly smaller clinics lack the appropriate facilities. Clinics and facilities that use controlled substances must maintain adequate and detailed records, but individual healthcare systems impose their own specific requirements. Some, for example, require drug disposal to be witnessed. However, recordkeeping systems must be robust and frequently audited to prevent diversion. Most healthcare systems want to dispose of controlled substances in an environmentally responsible way but in addition to federal laws in the United States, most states have their own environmental agencies and may have local regulations. Navigating this system can be complex, and since all regulations are subject to change, it requires vigilance and expertise.
RESUMO
Opioids affect the central nervous system and are known to produce dizziness, sleepiness, mood changes, and other actions that in some people have a negative impact on psychomotor or mental performance. The negative effects can be exacerbated in persons who are taking other prescription medications or illegal substances. Opioid-abusing drivers clearly represent an unnecessary danger to the public; although the vast majority of patients taking prescription opioids for pain safely drive to work and other activities, a subset may be impaired, but not be aware of or recognize the problem. The majority of pain patients would likely be surprised to learn that the legal systems in most parts of the world, including most states in the United States, do not differentiate between a pain patient taking a prescribed opioid at the right dose and frequency, and an abuser taking an illegal drug. For example, in some parts of the United States, a driver may be initially stopped for a relatively minor offense and, if the officer notices that the driver is wearing a fentanyl patch, charged with driving under the influence of drugs (DUID). The present narrative review attempts to highlight the existing problem, the different legal thresholds for arrest and prosecution for DUID, and the challenge of trying to have zero-tolerance for driving under the influence of a drug used illegally, while at the same time not arresting legitimate patients who are taking pain medication as prescribed. There is a clear and present need for an integrated assessment and addressing of the current confounding situation.
