The rise in non-fatal and fatal overdoses involving stimulants with and without opioids in the United States
The rise in non-fatal and fatal overdoses involving stimulants with and without opioids in the United States
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DOI：
10.1111/add.14878
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发表时间：
2020-01-07
期刊：
影响因子：
6
通讯作者：
Seth, Puja
中科院分区：
文献类型：
--
作者：
Hoots, Brooke;Vivolo-Kantor, Alana;Seth, Puja
目的：研究含阿片类和不含阿片类的兴奋剂非致命性和致命性过量用药率的趋势及近期变化，以完善对美国过量用药流行情况的描述性特征。
设计：对非致命性（2006 - 2016年）和致命性（2006 - 2017年）药物过量趋势进行二次分析，重点关注可获取数据的最近几年，以按人口统计学特征研究比率变化（非致命性为2015 - 2016年，致命性为2016 - 2017年）。
设置：来自医疗保健成本与利用项目全国急诊科样本的非致命性药物过量；来自国家生命统计系统的药物过量死亡数据。
参与者/病例：使用国际疾病分类第九版临床修订本（ICD - 9 - CM）和第十版临床修订本/操作编码系统（ICD - 10 - CM/PCS）中关于可卡因、精神兴奋剂和阿片类的编码对非致命性药物过量进行分类。使用ICD - 10多种死因编码识别可卡因、精神兴奋剂、所有阿片类、海洛因和合成阿片类导致的药物过量死亡。
测量指标：含阿片类和不含阿片类的可卡因和精神兴奋剂相关药物过量的年龄调整后的非致命性和致命性比率的变化百分比。
研究结果：总体而言，含阿片类的可卡因相关非致命性过量用药率从2006年到2016年有所上升[年百分比变化（APC）= 14.7]，而不含阿片类的比率从2006年到2012年上升（APC = 11.3），之后保持稳定（APC = -7.5）。含阿片类和不含阿片类的精神兴奋剂相关非致命性比率从2006年到2016年都有所上升（含阿片类APC = 49.9；不含阿片类APC = 13.9）。含阿片类和不含阿片类的可卡因相关死亡率从2014年到2017年有所上升（含阿片类APC = 46.0，不含阿片类APC = 23.6）。含阿片类的精神兴奋剂相关死亡率从2010年到2015年上升（APC = 28.6），从2015年到2017年急剧上升（APC = 50.5），而不含阿片类的比率从2008年到2017年上升（APC = 22.6）。2016年，27%的可卡因相关非致命性过量用药和14%的精神兴奋剂相关非致命性过量用药报告包含阿片类；2017年，72.7%的可卡因相关死亡和50.3%的精神兴奋剂相关死亡涉及阿片类。从2015年到2016年，含阿片类的可卡因相关和精神兴奋剂相关非致命性过量用药率分别上升了17.0%和5.9%；不含阿片类的可卡因相关和精神兴奋剂相关非致命性过量用药分别下降了13.6%和上升了18.9%。从2016年到2017年，含阿片类和不含阿片类的兴奋剂相关死亡率都有所上升（含阿片类和不含阿片类的可卡因分别为37.7%和23.3%；含阿片类和不含阿片类的精神兴奋剂分别为52.2%和23.0%）。从2016年到2017年，含合成阿片类的兴奋剂相关死亡率急剧上升（可卡因每10万人从1.3 - 2.3，精神兴奋剂从0.3 - 0.8）。
结论：虽然美国从2006年起可卡因相关死亡的增加似乎是由阿片类，特别是合成阿片类驱动的，但含阿片类和不含阿片类的精神兴奋剂相关的非致命性和致命性过量用药都在增加。
Aims To examine trends and recent changes in non-fatal and fatal stimulant overdose rates with and without opioids to improve the descriptive characterization of the US overdose epidemic. Design Secondary analysis of non-fatal (2006-16) and fatal (2006-17) drug overdose trends, focusing on the most recent years of data available to examine rate changes by demographics (2015-16 for non-fatal and 2016-17 for fatal). Setting Non-fatal drug overdoses from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample; drug overdose deaths from the National Vital Statistics System. Participants/cases International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) codes for cocaine, psychostimulants and opioids were used to classify non-fatal drug overdoses. Drug overdose deaths were identified using ICD-10 multiple cause-of-death codes for cocaine, psychostimulants, all opioids, heroin and synthetic opioids. Measurements Percentage of changes in age-adjusted non-fatal and fatal rates of cocaine and psychostimulant-involved drug overdose with and without opioids. Findings Overall, cocaine-involved non-fatal overdose rates with an opioid increased from 2006 to 2016 [annual percentage change (APC) = 14.7], while rates without an opioid increased from 2006 to 2012 (APC = 11.3) and then remained stable (APC = -7.5). Psychostimulant-involved non-fatal rates with and without an opioid increased from 2006 to 2016 (APC = 49.9 with opioids; 13.9 without opioids). Cocaine-involved death rates with and without opioids increased from 2014 to 2017 (APC = 46.0 with opioids, 23.6 without opioids). Psychostimulant-involved death rates with opioids increased from 2010 to 2015 (APC = 28.6), with a dramatic increase from 2015 to 2017 (APC = 50.5), while rates without opioids increased from 2008 to 2017 (APC = 22.6). In 2016, 27% of non-fatal cocaine- and 14% of psychostimulant-involved overdoses included a reported opioid; 72.7% of cocaine- and 50.3% of psychostimulant-involved deaths involved an opioid in 2017. From 2015 to 2016, cocaine-involved and psychostimulant-involved non-fatal overdose rates with an opioid increased 17.0 and 5.9%, respectively; cocaine-involved and psychostimulant-involved non-fatal overdoses without opioids decreased 13.6 and increased 18.9%, respectively. Death rates involving stimulants increased with and without opioids from 2016 to 2017 (cocaine with and without opioids = 37.7 and 23.3%; psychostimulants with and without opioids = 52.2 and 23.0%). Death rates involving stimulants with synthetic opioids increased dramatically from 2016 to 2017 (1.3-2.3 per 100 000 for cocaine and 0.3-0.8 for psychostimulants). Conclusions While increases in cocaine-involved deaths in the United States from 2006 seem to be driven by opioids, particularly synthetic opioids, increases in non-fatal and fatal overdoses involving psychostimulants are occurring with and without opioids.