An Assessment of Opioid Overdoses in San Francisco from 2010 through 2012

对 2010 年至 2012 年旧金山阿片类药物过量的评估

• 批准号: 8764664
• 负责人: PHILLIP O COFFIN
• 金额: $ 5.49万
• 依托单位: PUBLIC HEALTH FOUNDATION ENTERPRISES
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8764664
• 关键词: Address; Adult; Affect; Agonist; Alcohol or Other Drugs use; Antidotes; Behavioral; California; Censuses; Cessation of life; Characteristics; Cities; Client; Clinical; Clinical Data; Collaborations; Comorbidity; County; Crime; Data; Data Set; Data Sources; Databases; Death Rate; Development; Drug Monitoring; Drug usage; Education Projects; Effectiveness of Interventions; Electronics; Funding; Future; Goals; HIV; Healthcare; Healthcare Systems; Heroin; Housing; Improve Access; Incidence; Income; Income Distributions; Injury; Intervention; Life; Maintenance; Medical; Medical Examiners; Medical Records; Methods; Modeling; Monitor; Morbidity - disease rate; Naloxone; Narcotic Antagonists; Neighborhoods; Opioid; Opioid Analgesics; Outcome; Overdose; Patient Care; Persons; Pharmaceutical Preparations; Poisoning; Police; Population; Population Characteristics; Prevention education; Primary Health Care; Public Health; Records; Reporting; Research; Risk; San Francisco; Services; Source; Spatial Distribution; System; Toxicology; United States; United States Public Health Service; Vital Statistics; Woman; administrative database; cohort; demographics; economic cost; heroin overdose; high risk; men; methadone maintenance; mortality; novel; overdose death; overdose prevention; prescription opioid; programs; public health relevance; safety net; trend

DESCRIPTION (provided by applicant): Drug poisoning is now the leading cause of accidental death among adults in the U.S. and opioid analgesic overdose deaths dramatically increased by over 400% and 265% among women and men, respectively, from 1999-2010. The economic cost of opioid-related poisoning was estimated at $20.4 billion in the United States for 2009. Addressing opioid overdose is consistent with the White House goal of reducing drug-induced morbidity and mortality by 15%. San Francisco, historically a leading city for opioid use and related morbidity, witnessed a dramatic decline in heroin-related mortality after improving access to agonist maintenance services and implementing city-wide distribution of naloxone (the short-acting opioid antagonist used to reverse opioid overdose). However, a surge in opioid analgesic mortality negated much of this mortality benefit. We still understand little about "who" dies from opioid analgesics since there is no local system for monitoring opioid overdose indicators. Moreover, it is unclear how agonist maintenance services and naloxone distribution correlate with geographic concentration of opioid overdose deaths. To effectively respond to opioid overdose, it is critical to develop methods to identify and monitor overdose trends and evaluate the effectiveness of interventions. We propose a secondary analysis of opioid overdose decedent data collected from the California State Electronic Death Reporting System (EDRS) matched with data from the public substance use treatment record database and chart review of all patients cared for in the safety net healthcare system affiliated with the San Francisco Department of Public Health. We will evaluate annuals trends in opioid overdose deaths for San Francisco, overall and by neighborhood using Poisson regression models form 2010-2012 (aim 1). We will also describe the demographic and clinical characteristics of opioid overdose decedents in San Francisco County using toxicology and medical and substance use treatment records (aim 2). W explores the spatial overlap between opioid overdose decedents, lay naloxone distribution and lay naloxone use (aim 3). In exploratory aims, we will calculate the rate of opioid overdose mortality using US census, National HIV Behavioral Surveillance, and prescription drug monitoring program data for denominators, and conduct ecological analyses to look at the relationship between opioid overdose deaths and neighborhood-level factors. Findings from this study will inform the development of a local surveillance system to track opioid-related outcomes, strengthen the capacity to monitor opioid overdose mortality and enhance interventions to reduce opioid overdose mortality.

描述（由申请人提供）：药物中毒现在是美国成年人意外死亡的主要原因，从1999年到2010年，女性和男性阿片类镇痛药过量死亡人数分别急剧增加了400%和265%以上。2009年，美国类阿片相关中毒的经济成本估计为204亿美元。解决阿片类药物过量与白宫将药物引起的发病率和死亡率降低15%的目标一致。旧金山弗朗西斯科历来是阿片类药物使用和相关发病率的主要城市，在改善了激动剂维持服务的可及性并在全市范围内分发纳洛酮（用于逆转阿片类药物过量的短效阿片类拮抗剂）后，海洛因相关死亡率大幅下降。然而，阿片类镇痛药死亡率的激增抵消了这种死亡率的大部分好处。我们仍然对“谁”死于阿片类镇痛剂知之甚少，因为没有监测阿片类药物过量指标的地方系统。此外，目前还不清楚激动剂维持服务和纳洛酮分布与阿片类药物过量死亡的地理集中度之间的关系。为了有效应对阿片类药物过量，至关重要的是要制定方法来确定和监测过量趋势，并评估干预措施的有效性。我们建议对从加州州电子死亡报告系统（EDRS）收集的阿片类药物过量死者数据进行二次分析，这些数据与来自公共物质使用治疗记录数据库的数据相匹配，并对弗朗西斯科公共卫生部下属的安全网医疗保健系统中的所有患者进行图表审查。我们将使用泊松回归模型评估2010-2012年旧金山弗朗西斯科阿片类药物过量死亡的年度趋势（目标1）。我们还将使用毒理学、医疗和物质使用治疗记录描述旧金山弗朗西斯科县阿片类药物过量死亡者的人口统计学和临床特征（目的2）。W探索阿片类药物过量死亡者、非专业纳洛酮分布和非专业纳洛酮使用之间的空间重叠（目的3）。在探索性目标中，我们将使用美国人口普查，国家艾滋病毒行为监测和处方药监测计划数据计算阿片类药物过量死亡率，并进行生态分析，以了解阿片类药物过量死亡与社区因素之间的关系。这项研究的结果将为当地监测系统的发展提供信息，以跟踪阿片类药物相关的结果，加强监测阿片类药物过量死亡率的能力，并加强干预措施以减少阿片类药物过量死亡率。