Patterns of Abuse Among Unintentional Pharmaceutical Overdose Fatalities
Patterns of Abuse Among Unintentional Pharmaceutical Overdose Fatalities
复制标题
DOI：
10.1001/jama.2008.802
复制
发表时间：
2008-12-10
影响因子：
120.7
通讯作者：
Paulozzi, Leonard J.
中科院分区：
文献类型：
--
作者：
Hall, Aron J.;Logan, Joseph E.;Paulozzi, Leonard J.
自1990年以来，美国处方麻醉性镇痛药的使用和滥用急剧增加。这种药物流行病的影响在包括西弗吉尼亚州在内的农村州最为明显，西弗吉尼亚州在1999- 2004年期间经历了全国最大的药物过量死亡率增长。目的评估西弗吉尼亚州因意外药物过量死亡的风险特征，涉及的药物类型以及药物滥用在死亡中的作用。和参与者基于人群的观察性研究，使用的数据来自体检医师、处方药监测项目和阿片类药物治疗项目记录。研究人群为2006年西弗吉尼亚州因药物过量意外死亡的所有州居民。主要结果测量所选人口统计学变量的发生率和发生率比。死亡者中特定药物的流行率和为死亡者开处方的比例。人口统计学和药物滥用指标与药物转移证据之间的关联，药物转移的证据定义为涉及处方药的死亡，没有处方记录，并且在死亡前一年内从5名或更多临床医生那里获得了受控药物的处方结果在295例死亡者中，198例（67.1%）为男性，271例（91.9%）年龄在18岁至54岁之间。药物转移与186例（63.1%）死亡相关，而63例（21.4%）伴随着医生购物的证据。18至24岁死亡者中转移的流行率最高，并在每个连续的年龄组中下降。与男性（33 [ 16.7%]）和其他年龄组（40 [ 18.2%]）相比，女性（30 [ 30.9%]）和35至44岁的死者（23 [ 30.7%]）在死亡前一年从5名或更多临床医生处获得受控物质处方更为常见。在279名死者（94.6%）中确定了药物滥用指标，非医疗暴露途径和非法贡献药物在药物转移者中特别普遍。234例死亡（79.3%）涉及多种贡献物质。阿片类镇痛药采取了275死者（93.2%），其中只有122（44.4%）曾经规定这些drugs.Conclusion大多数过量死亡在西弗吉尼亚州2006年与非医疗用途和药物，主要是阿片类镇痛药的分流。
Context Use and abuse of prescription narcotic analgesics have increased dramatically in the United States since 1990. The effect of this pharmacoepidemic has been most pronounced in rural states, including West Virginia, which experienced the nation's largest increase in drug overdose mortality rates during 1999- 2004.Objective To evaluate the risk characteristics of persons dying of unintentional pharmaceutical overdose in West Virginia, the types of drugs involved, and the role of drug abuse in the deaths.Design, Setting, and Participants Population- based, observational study using data from medical examiner, prescription drug monitoring program, and opiate treatment program records. The study population was all state residents who died of unintentional pharmaceutical overdoses in West Virginia in 2006.Main Outcome Measures Rates and rate ratios for selected demographic variables. Prevalence of specific drugs among decedents and proportion that had been prescribed to decedents. Associations between demographics and substance abuse indicators and evidence of pharmaceutical diversion, defined as a death involving a prescription drug without a documented prescription and having received prescriptions for controlled substances from 5 or more clinicians during the year prior to death ( ie, doctor shopping).Results Of 295 decedents, 198 ( 67.1%) were men and 271 ( 91.9%) were aged 18 through 54 years. Pharmaceutical diversion was associated with 186 ( 63.1%) deaths, while 63 ( 21.4%) were accompanied by evidence of doctor shopping. Prevalence of diversion was greatest among decedents aged 18 through 24 years and decreased across each successive age group. Having prescriptions for a controlled substance from 5 or more clinicians in the year prior to death was more common among women (30 [ 30.9%]) and decedents aged 35 through 44 years ( 23 [ 30.7%]) compared with men ( 33 [ 16.7%]) and other age groups ( 40 [ 18.2%]). Substance abuse indicators were identified in 279 decedents ( 94.6%), with nonmedical routes of exposure and illicit contributory drugs particularly prevalent among drug diverters. Multiple contributory substances were implicated in 234 deaths ( 79.3%). Opioid analgesics were taken by 275 decedents (93.2%), of whom only 122 ( 44.4%) had ever been prescribed these drugs.Conclusion The majority of overdose deaths in West Virginia in 2006 were associated with nonmedical use and diversion of pharmaceuticals, primarily opioid analgesics.