Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances
Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances
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DOI：
10.1016/j.drugalcdep.2017.05.047
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发表时间：
2017-09-01
影响因子：
4.2
通讯作者：
Wall, Melanie
中科院分区：
文献类型：
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作者：
Kandel, Denise B.;Hu, Mei-Chen;Wall, Melanie
背景：在过去十年中，处方阿片类药物（PO）过量死亡急剧增加。PO死亡与其他精神活性物质结合的变化可能提供了部分解释。方法：对2002 - 03年（N = 15，973）和2014 - 15年（N = 41，491）国家多死因死亡文件中的PO死亡进行了分析。我们计算了（1）两个时期之间与苯二氮卓类药物、抗抑郁药、海洛因、酒精、可卡因联合使用的死亡比例的变化，以及（2）PO和除美沙酮以外的合成阿片类药物（SO-M）死亡中每种物质导致的死亡增加比例，按年龄、性别、种族/民族分类。在2002 - 03年和2014 - 15年之间，PO死亡增加了2.6倍; SO-M死亡增加了5.6倍，特别是18 - 34岁的男性，非洲裔美国人。对于PO死亡，两个阶段最常见的联合用药为苯二氮卓类;对于SO-M，2002 - 03年为苯二氮卓类、抗抑郁药，2014 - 15年为海洛因、苯二氮卓类。在所有PO中，与海洛因联合用药的死亡率增幅最大（4.6%-15.4%，变化率= 3.3 [95%CI = 3.1 - 3.6]），但SO-M死亡率增幅尤其大（1.2%-24.5%，变化率= 21.3 [95%CI = 15.0 - 30.3]）。涉及可卡因的死亡在PO中减少，在SO-M死亡中增加。五分之一的PO或SO-M死亡增加可归因于五种物质中的任何一种。PO死亡的增加同样归因于苯二氮卓类药物和海洛因; 18 - 49岁男性和非西班牙裔白人中归因于海洛因的死亡较高。增加SO-M死亡主要归因于海洛因之间的所有groups.Conclusions：增加PO过量死亡在过去十年中，可能部分解释增加死亡与其他精神活性物质相结合。在减少处方阿片类药物过量的努力中，应考虑使用其他物质。
Background: Prescription opioid (PO) overdose deaths increased sharply over the last decade. Changes in PO deaths in combination with other psychoactive substances may provide a partial explanation.Methods: PO deaths from the National Multiple-Cause-of-Death Files for 2002-03 (N = 15,973) and 2014-15 (N = 41,491) were analyzed. We calculated (1) changes in proportions of deaths in combination with benzo-diazepines, antidepressants, heroin, alcohol, cocaine between the two periods, and (2) proportions of increase in deaths attributable to each substance among PO and synthetic opioids other than methadone (SO-M) deaths, by age, gender, race/ethnicity.Results: Between 2002-03 and 2014-15, PO deaths increased 2.6 times; SO-M deaths 5.6 times, especially for ages 18-34, males, African-Americans. For PO deaths, most frequent combinations at both periods were with benzodiazepines; for SO-M, benzodiazepines, antidepressants in 2002-03, heroin, benzodiazepines in 2014-15. The largest increases occurred in combination with heroin among all PO (4.6% to 15.4%, change ratio = 3.3[95%CI = 3.1-3.6]), but especially SO-M deaths (1.2% to 24.5%, change ratio = 21.3[95%CI = 15.0-30.3]). Deaths involving cocaine decreased among PO, increased among SO-M deaths. One-fifth of increased PO or SO-M deaths were attributable to any of the five substances. Increased PO deaths were equally attributable to benzodiazepines and heroin; deaths attributable to heroin were higher among ages 18-49, males, and non-Hispanic whites. Increased SO-M deaths were attributable mostly to heroin among all groups.Conclusions: Increased PO overdose deaths over the last decade may be partially explained by increased deaths in combination with other psychoactive substances. Use of other substances should be considered in efforts toward reducing prescription opioid overdoses.