In 2020, three crises coalesced to transform the clinical care landscape of addiction medicine in the United States (US). The opioid overdose crisis (crisis #1), which had been contributing to excess US mortality for over two decades, worsened during the COVID-19 pandemic (crisis #2). The racial reckoning (crisis #3) spurred by the murder of George Floyd at the hands of police impacted clinical care, especially in safety net clinical settings where the majority of people targeted by police violence, and other forms of structural violence, receive healthcare to mend both physical and psychological wounds. Collectively, the three crises changed how providers and patients viewed their experiences of clinical surveillance and altered their relationships to the violence of US healthcare. Drawing from two different research studies conducted during the years preceding and during the COVID-19 pandemic (2017–2022) with low income, safety net patients at risk for opioid overdose and their care providers, I analyze the relationship between surveillance and violence in light of changes wrought by these three intersecting health and social crises. I suggest that shifting perceptions about surveillance and violence contributed to clinical care innovations that offer greater patient autonomy and transform critical components of addiction medicine care practice.

2020 年，三场危机共同改变了美国成瘾医学的临床护理格局。阿片类药物过量危机（危机#1）二十多年来一直导致美国死亡率过高，在 COVID-19 大流行期间恶化（危机#2）。乔治·弗洛伊德被警察谋杀引发的种族清算（危机＃3）影响了临床护理，特别是在安全网临床环境中，大多数受到警察暴力和其他形式结构性暴力侵害的人都接受医疗保健治愈身体和心理的创伤。总的来说，这三场危机改变了提供者和患者看待临床监测经历的方式，并改变了他们与美国医疗保健暴力的关系。根据在 COVID-19 大流行之前和期间（2017-2022 年）针对低收入、有阿片类药物过量风险的安全网患者及其护理人员进行的两项不同的研究，我分析了监视与暴力之间的关系这三个相互交叉的健康和社会危机所造成的变化。我认为，对监视和暴力的看法的转变有助于临床护理创新，为患者提供更大的自主权，并改变成瘾医学护理实践的关键组成部分。