Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances
Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances
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DOI：
10.1186/s12954-019-0354-y
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发表时间：
2020-01-09
影响因子：
4.4
通讯作者：
Johnson, Bjorn
中科院分区：
文献类型：
--
作者：
Andersson, Lisa;Hakansson, Anders;Johnson, Bjorn
背景近几十年来，西方国家与阿片类药物相关的死亡人数有所增加。尽管有许多研究调查了与阿片类药物有关的死亡率，但只有少数几项研究侧重于死者死前的生活，特别是与卫生、社会和惩教服务等提供护理的当局的联系。此外，在过去二十年中，引起大多数死亡的类阿片发生了变化，从海洛因到处方类阿片。然而，比较不同物质导致的死亡的研究很少。本研究的目的是调查因阿片类药物中毒死亡的个人在死亡前一年与提供护理的当局的联系，并分析与阿片类药物导致其死亡有关的差异。该研究基于回顾性登记数据，包括2012年1月1日至2013年12月31日和2014年7月1日至2016年6月30日期间在瑞典Skane死于阿片类药物中毒的180名有非法药物使用史的人。包括海洛因、美沙酮、丁丙诺啡和芬太尼引起的中毒。数据收集自国家法医委员会、区域保健服务机构、市政社会服务机构以及监狱和缓刑犯管理局。采用Pearson卡方检验、Fisher精确检验和Mann-Whitney U检验进行统计学检验，以分析组间差异。在死亡前一年，共有89%的死者与一个或多个提供护理的机构接触; 75%的人与医疗保健机构接触，69%的人与社会服务机构接触，28%的人与监狱和缓刑服务机构接触，23%的人在生命的最后一年的某个时候参加了阿片类药物替代治疗。在哪种阿片类药物导致死亡方面，药物组之间几乎没有差异。除阿片类药物外，80%以上的病例中还存在镇静剂。与丁丙诺啡有关的死亡者在死亡前一年与社会服务部门的接触程度要低得多。结论研究人群的特点是与提供护理的当局广泛接触，从而为当局提供了许多机会，以达到这一群体的预防和其他干预措施。在哪种阿片类药物导致死亡方面，各组之间几乎没有差异。
Background Opioid-related deaths have increased in Western countries over recent decades. Despite numerous studies investigating opioid-related mortality, only a few have focused on the lives of the deceased individuals prior to their deaths, specifically regarding contact with care-providing authorities such as health, social and correctional services. Furthermore, a change has been noted in the last two decades as to which opioids cause most deaths, from heroin to prescription opioids. However, studies comparing fatalities caused by different substances are rare. The aim of this study was to investigate contact with care-providing authorities during the year prior to death among individuals who died as a result of opioid intoxication and to analyse differences relating to which opioids caused their deaths. Methods The study is based on retrospective register data and includes 180 individuals with a history of illicit drug use, who died from opioid intoxication in Skane, Sweden, between 1 January 2012 to 31 December 2013 and 1 July 2014 to 30 June 2016. Intoxications caused by heroin, methadone, buprenorphine and fentanyl were included. Data were collected from the National Board of Forensic Medicine, regional health care services, municipal social services and the Prison and Probation Service. Statistical testing was performed using Pearson's chi-square test, Fisher's exact test and the Mann-Whitney U test to analyse group differences. Results A total of 89% of the deceased individuals had been in contact with one or more of the care-providing authorities during the year prior to death; 75% had been in contact with health care, 69% with the social services, 28% with the Prison and Probation Service, and 23% had been enrolled in opioid substitution treatment at some point during their final year of life. Few differences appeared between the substance groups with regard to which opioid contributed to the death. In addition to opioids, sedatives were present in more than 80% of the cases. Individuals whose deaths were buprenorphine-related had been in contact with the social services to a significantly lesser extent during the year prior to death. Conclusions The studied population is characterised by extensive contact with care-providing authorities, thus providing numerous opportunities for authorities to reach this group with preventive and other interventions. Few differences emerged between groups with regard to which opioid had contributed to the death.