Increased use of heroin as an initiating opioid of abuse
Increased use of heroin as an initiating opioid of abuse
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DOI：
10.1016/j.addbeh.2017.05.030
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发表时间：
2017-11-01
影响因子：
4.4
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.
导言：考虑到最近海洛因使用的相对增长和对阿片类药物使用的更宽松的氛围，我们假设越来越多对阿片类药物缺乏经验和耐受性的人会将海洛因作为他们的第一个阿片类药物而不是更常见的处方阿片类止痛剂进行实验。方法：2010-2016年间因阿片类药物使用障碍而接受药物滥用治疗的个人(N=5885)被问及他们第一次经常使用的特定阿片类药物以获得快感的情况。为了限制长期回忆和生存偏差，分析限于过去十年(2005年-2015年)发生的阿片类药物起效。结果：2005年，只有8.7%的阿片类药物起始者使用海洛因，但这一比例在2015年急剧增加到33.3%(p<；0.001)，没有稳定的证据。2015年，常用处方阿片类药物羟可酮和羟可酮的使用率分别从42.4%和42.3%下降到24.1%和27.8%，因此海洛因作为一种启动阿片类药物现在得到的认可比处方阿片类止痛剂更频繁。结论：我们的数据文件显示，由于供应方的干预，作为最常见的阿片类药物氢可酮和羟可酮的使用变得越来越难获得，海洛因作为启动阿片类药物的使用以惊人的速度增长。鉴于阿片新手对阿片类药物的耐受性有限，海洛因使用中固有的剂量轻微不准确很可能是近年来海洛因相关过量死亡人数增加的一个重要因素。
Introduction: Given the relatively recent growth in access to heroin and a more permissive atmosphere surrounding its use, we hypothesized that an increasing number of persons with limited experience and tolerance to opioids would experiment with heroin as their first opioid rather than more common prescription opioid analgesics.Methods: Individuals entering substance abuse treatment for an opioid use disorder in the period 2010-2016 (N = 5885) were asked about the specific opioid they first regularly used to get high. To limit long-term recall and survival bias, analyses was restricted to opioid initiation that occurred in the past ten years (2005-2015).Results: In 2005, only 8.7% of opioid initiators started with heroin, but this sharply increased to 33.3% (p < 0.001) in 2015, with no evidence of stabilization. The use of commonly prescribed opioids, oxycodone and hydrocodone, dropped from 42.4% and 42.3% of opioid initiators, respectively, to 24.1% and 27.8% in 2015, such that heroin as an initiating opioid was now more frequently endorsed than prescription opioid analgesics.Conclusions: Our data document that, as the most commonly prescribed opioids hydrocodone and oxycodone became less accessible due to supply-side interventions, the use of heroin as an initiating opioid has grown at an alarming rate. Given that opioid novices have limited tolerance to opioids, a slight imprecision in dosing inherent in heroin use is likely to be an important factor contributing to the growth in heroin-related over dose fatalities in recent years.