Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis
Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis
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DOI：
10.2105/ajph.2019.305412
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发表时间：
2020-02-01
影响因子：
12.7
通讯作者：
Kasper, Zachary A.
中科院分区：
文献类型：
--
作者：
Cicero, Theodore J.;Ellis, Matthew S.;Kasper, Zachary A.
目标。了解美国阿片类药物流行中阿片类药物和非阿片类药物共同发生的使用（即多物质使用）的重要变化。我们分析了来自全国15741名正在接受阿片类药物使用障碍治疗的患者的调查数据，分析了过去一个月处方和非法阿片类药物以及12种非阿片类精神活性药物的共同使用情况。过去一个月的非法阿片类药物使用率从2011年的44.8%上升到2018年的70.1%，而处方阿片类药物的使用率从55.2%下降到29.9%，但总体上仍然很高（94.5%至85.2%）。几乎所有参与者在过去一个月至少使用过一种非阿片类药物，甲基苯丙胺的使用显著增加（+85%），非阿片类处方药的使用明显减少（范围：-40%至-68%）。孤立地看待阿片类药物的趋势不仅忽视了阿片类药物使用在阿片类药物使用障碍患者中普遍存在的事实，而且还忽视了应与阿片类药物趋势一起监测多物质使用的重大变化。公共卫生影响。治疗、预防和政策制定不仅要解决单一药物类别的供应和需求问题，还要解决药物使用总体的全球性问题。
Objectives. To understand important changes in co-occurring opioid and nonopioid drug use (i.e., polysubstance use) within the opioid epidemic in the United States.Methods. We analyzed survey data on the past month co-use of prescription and illicit opioids and 12 nonopioid psychoactive drug classes from a national sample of 15 741 persons entering treatment of opioid use disorder.Results. Past-month illicit opioid use increased from 44.8% in 2011 to 70.1% in 2018, while the use of prescription opioids alone dropped from 55.2% to 29.9%, yet overall remained high (94.5% to 85.2%). Past-month use of at least 1 nonopioid drug occurred in nearly all participants (> 90%), with significant increases in methamphetamine (+85%) and decreases across nonopioid prescription drug classes (range: -40% to -68%).Conclusions. Viewing opioid trends in a "silo" ignores the fact not only that polysubstance use is ubiquitous among those with opioid use disorder but also that significant changes in polysubstance use should be monitored alongside opioid trends.Public Health Implications. Treatment, prevention, and policymaking must address not only the supply and demand of a singular drug class but also the global nature of substance use overall.