Fentanyl shock: The changing geography of overdose in the United States
Fentanyl shock: The changing geography of overdose in the United States
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DOI：
10.1016/j.drugpo.2019.04.010
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发表时间：
2019-08-01
影响因子：
4.4
通讯作者：
Zoorob, Michael
中科院分区：
文献类型：
--
作者：
Zoorob, Michael
背景：自 2014 年以来，美国药物过量死亡人数迅速增加，且区域分层程度较高，其中东部和东北部各州增幅最大。相比之下，许多西部州的服药过量死亡人数趋于稳定。本文展示了药物供应中芬太尼和芬太尼类似物的不同流入如何重塑了美国药物过量危机的地理和人口特征。方法：利用根据《信息自由法》要求获得的所有国家实验室缉获的药物，我通过描述性图表和统计模型分析了美国药物供应中芬太尼的区域差异。主要分析使用双向固定效应普通最小二乘 (OLS) 回归和两阶段最小二乘回归 (2SLS) 仪器来探讨芬太尼暴露的州年用药过量趋势，其中州经度乘以线性趋势。结果：首先，芬太尼暴露与地理高度相关，并且只能用 2014 年之前的用药过量率来解释。东部各州（经度较高）受到的影响要严重得多。其次，芬太尼暴露对服药过量死亡率具有统计上显着且重要的影响，模型预测的死亡与官方死亡统计数据大致一致。第三，芬太尼暴露解释了2011年至2017年间药物过量死亡率增加的大部分变化。因此，这些年来药物过量危机的震中转移到了美国东部。结论：这些发现揭示了药物过量流行的“第三波”，其特点是药物供应的快速且不同地区的变化，增加了药物过量的风险。最重要的是，他们强调，鉴于毒品环境迅速变化，迫切需要采取循证政策来打击毒瘾。
Background: Rapid increases in drug overdose deaths in the United States since 2014 have been highly regionally stratified, with the largest increases occurring in the eastern and northeastern states. By contrast, many western states saw overdose deaths plateau. This paper shows how the differential influx of fentanyl and fentanyl analogues in the drug supply has reshaped the geography and demography of the overdose crisis in the United States.Methods: Using all state lab drug seizures obtained by Freedom of Information Act request, I analyze the regionally distinctive presence of fentanyl in the US drug supply with descriptive plots and statistical models. Main analyses explore state-year overdose trends using two-way fixed effects ordinary least squares (OLS) regression and two-stage least squares regression (2SLS) instrumenting for fentanyl exposure with state-longitude times a linear trend.Results: First, fentanyl exposure is highly correlated with geography and only weakly explained by overdose rates prior to 2014. States in the east (higher degrees longitude) are much more heavily affected. Second, fentanyl exposure exhibits a statistically significant and important effect on overdose mortality, with model-predicted deaths broadly consistent with official death statistics. Third, fentanyl exposure explains most of the variation in increased overdose mortality between 2011 and 2017. Consequently, the epicenter of the overdose crisis shifted towards the eastern United States over these years.Conclusion: These findings shed light on the "third-wave" of the overdose epidemic, characterized by rapid and geographically disparate changes in drug supply that heighten the risk of overdose. Above all, they underscore the urgency of adopting evidence-based policies to combat addiction in light of the rapidly changing drug environment.