Carfentanil-Associated Mortality in Wayne County, Michigan, 2015-2017
Carfentanil-Associated Mortality in Wayne County, Michigan, 2015-2017
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DOI：
10.2105/ajph.2018.304814
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发表时间：
2019-02-01
影响因子：
12.7
通讯作者：
Hlavaty, Leigh
中科院分区：
文献类型：
--
作者：
King, Andrew;Foley, Daniel;Hlavaty, Leigh
目标。旨在确定 2016 年 7 月至 2017 年 2 月期间与密歇根州韦恩县阿片类药物相关死亡率激增相关的阿片类药物。方法。我们审查了韦恩县法医办公室的记录，其中记录了 2015 年 7 月至 2017 年 7 月期间因意外非医疗处方阿片类药物过量而死亡的 645 人。我们分析了基本人口统计数据、死亡地点和所有阿片类药物毒理学结果。在医院死亡的死者被排除在外。结果。在因非医疗处方阿片类药物过量而死亡的 645 人中，65% 是男性，63% 是白人，平均年龄 43 岁。在 129 例（20%）病例中检出卡芬太尼。在 8 个月的死亡率高峰期间，419 例病例中有 114 例检测到卡芬太尼（平均值 = 27.2%；范围 = 6.4%-45.2%）。卡芬太尼最常检测到的物质包括吗啡 (57%)、6-单乙酰吗啡 (38%)、芬太尼 (43%)、去甲芬太尼 (33%)、四氢大麻酚 (34%) 和可卡因 (29%)。结论。韦恩县的死亡率峰值与卡芬太尼的检测相对应，并且与可检测到卡芬太尼的阿片类药物过量死亡比例相应增加。公共健康影响。卡芬太尼检测死亡率突然下降，恰逢中国即将禁止芬太尼类似物的公告，这表明源头控制是一种有效的对策。
Objectives. To identify opioids associated with a spike in opioid-related mortality in Wayne County, Michigan, from July 2016 through February 2017.Methods. We reviewed records from the Wayne County Medical Examiner's Office of 645 people who died because of accidental nonmedically prescribed opioid overdoses from July 2015 through July 2017. We analyzed basic demographics, locations of death, and all opioid toxicology results. Decedents who died in hospitals were excluded.Results. Of the 645 people who died because of nonmedically prescribed opioid overdoses, 65% were male and 63% were White, with an average age of 43 years. Carfentanil was detected in 129 (20%) cases. During the 8-month mortality spike, carfentanil was detected in 114 of 419 cases (average = 27.2%; range = 6.4%-45.2%). Substances most frequently detected with carfentanil included morphine (57%), 6-monoacetylmorphine (38%), fentanyl (43%), norfentanyl (33%), tetrahydrocannabinol (34%), and cocaine (29%).Conclusions. The Wayne County spike in mortality temporally corresponded with the detection of carfentanil and a proportional increase in opioid overdose deaths with detectable carfentanil.Public Health Implications. The abrupt decrease in carfentanil-detected mortality coincided with an announcement indicating an impending ban on fentanyl analogs from China, which suggests that source control is an effective countermeasure.