The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis.
The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis.
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DOI：
10.1097/yco.0000000000000717
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发表时间：
2021-07-01
影响因子：
6.9
通讯作者：
Ciccarone D
中科院分区：
文献类型：
--
作者：
Ciccarone D
本综述提供了最近发表的关于非法芬太尼的增加、过量用药的风险、与其他物质的组合，如兴奋剂、后果和治疗方面的最新文献。在新冠肺炎大流行之前和期间，美国非法合成阿片类药物(例如芬太尼和芬太尼类似物)造成的过量用药继续上升。在新的地理区域，如美国西部，与芬太尼相关的过量用药正在上升。在甲基苯丙胺和可卡因的推动下，与兴奋剂相关的过量用药在全国范围内也在增加。多物质使用，例如，兴奋剂和阿片类药物的使用正在推动兴奋剂相关的过量使用。注射吸毒的其他医疗后果正在上升，包括艾滋病毒和丙型肝炎感染。治疗阿片类药物使用障碍的药物方法仍然是护理的标准，而且有治疗甲基苯丙胺使用障碍的新的有希望的药理学方法。在美国，与使用甲基苯丙胺和可卡因有关的“第四波”高死亡率正在积聚力量。非法芬太尼的供应和使用仍然是过量死亡的主要驱动因素，目前与兴奋剂有关的死亡人数的上升似乎与持续的阿片类药物流行交织在一起。
This review provides an update on recent published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences and treatment. Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both preceding and during the COVID-19 pandemic. Fentanyl-related overdose is rising in new geographic areas e.g. the western US. Stimulant-related overdose is also increasing nationwide driven by methamphetamine and cocaine. Polysubstance use, e.g. the use of a stimulant along with an opioid is driving stimulant-related overdose. Other medical consequences of injection drug use are rising including HIV and hepatitis C infections. Medication approaches to treating opioid use disorder remain the standard of care and there are new promising pharmacological approaches to treating methamphetamine use disorder. A ‘fourth wave’ of high mortality involving methamphetamine and cocaine use has been gathering force in the US. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.