Leveraging state drug overdose data to build a comprehensive case level national dataset to inform prevention and mitigation strategies.

项目摘要 2021年，80，816名美国居民死于与阿片类药物有关的过量死亡-惊人的100倍增长 自1999年以来。随着药物供应、药物需求和政策的变化，阿片类药物危机继续演变 干预自2019年以来，危机已转变为高死亡率的“第四波”，其特征是 合成阿片类药物与兴奋剂的混合物，如可卡因或甲基苯丙胺。合成阿片类药物， 特别是芬太尼及其类似物，仍然是过量死亡的主要驱动因素。我们可以确定 合成阿片类药物，因为我们有全国性的数据来跟踪死亡的物质，年龄，种族，民族，性别， 和地理位置。我们没有及时的国家数据表明兴奋剂的作用增加 阿片类药物过量死亡很大程度上，我们没有意识到阿片类药物危机已经在全国范围内转移， 直到含有兴奋剂的致命芬太尼鸡尾酒开始使用两年后才被释放。此外，委员会认为， 我们对个别死者的个人资料知之甚少。如果我们想遏制阿片类药物过量 死亡和应对兴奋剂在致命药物组合中的使用升级，我们需要了解 这些死亡沿着突发事件、个人和病史、既往 治疗尝试，与刑事司法系统的相互作用，毒理学结果，药物来源，药物形式， 给药途径和阿片类药物过量死亡的其他相关因素。这些数据是存在的，但目前它们 在其当前状态下不可公开获得、集中或使用。这项研究将解决这一关键问题。 阿片类药物研究中的数据限制。为了制定预防和缓解战略，我们将利用关键的时间- 致命药物过量的法医学调查的敏感信息。这些调查产生了 来自死亡证明、执法部门、毒理学和验尸官/法医报告的数据。的报告 包含结构化和非结构化的叙述性数据，这些数据描述了每起死亡事件的情况。 目前，研究人员只能通过限制访问访问这些报告的自杀和他杀， 与联邦政府的数据协议。阿片类药物引起的自杀和杀人虽然有用， 中毒仅占阿片类药物过量死亡的6%。获取其余94%的详细信息 “无意”阿片类药物过量死亡，我们需要相同的数据元素和叙述，从个人 州政府。我们将确保有意和无意的过量记录，整合和挖掘 这些数据，以确定以前未经审查的突发事件，个人历史和情况， 吸毒过量死亡的相关信息此外，我们将量化人口和区域变化， 阿片类药物过量死亡涉及的物质类型。这些目标将为预防和缓解提供信息 这些努力包括关键干预点和药物供应的变化。我们创建的数据库不会 只有让我们实现这些目标，才能解决涉及芬太尼的阿片类药物危机， 兴奋剂，但将为未来的广泛研究奠定基础。

Project Summary In 2021, 80,816 US residents died from an opioid-related overdose death—an astounding 100-fold increase since 1999. The opioid crisis continues to evolve with changes in the drug supply, drug demand, and policy intervention. Since 2019, the crisis has shifted into a ‘fourth wave’ of high mortality, characterized by the mixture of synthetic opioids with stimulants, such as cocaine or methamphetamine. Synthetic opioids, specifically fentanyl and its analogs, are still the major driver of overdose deaths. We can identify the role of synthetic opioids because we have national data to track deaths by substance, age, race, ethnicity, gender, and geographical location. What we don’t have is timely national data signaling the increased role of stimulants in opioid overdose deaths. Largely, we were unaware that the opioid crisis had shifted nationally because data were not released until two years after the onset of lethal fentanyl cocktails that included a stimulant. Moreover, we know very little about the personal details of individual decedents. If we want to curb opioid overdose deaths and respond to the escalating use of stimulants in fatal drug combinations, we need to understand the context in which those deaths occur sooner along with precipitating events, personal and medical history, prior treatment attempts, interactions with the criminal justice system, toxicology results, drug sources, drug forms, routes of administration, and other correlates of opioid overdose deaths. These data exist, but currently they are not publicly available, centralized, or usable in their current state. The proposed study will solve this key data limitation in opioid research. To inform prevention and mitigation strategies, we will leverage critical, time- sensitive information from medicolegal investigations of fatal drug overdoses. These investigations produce data from death certificates, law enforcement, toxicology, and coroner/medical examiner reports. The reports contain both structured and unstructured narrative data, which describe the circumstances around each death. Currently, researchers can only access these reports for suicides and homicides through Restricted Access to Data agreements with the federal government. While useful, suicides and homicides caused by opioid poisoning account for only 6% of opioid overdose deaths. To obtain detailed information on the remaining 94% of “unintentional” opioid overdose deaths, we need the same data elements and narratives from individual state governments. We will secure both intentional and unintentional overdose records, integrate, and mine these data to identify previously unexamined precipitating events, personal histories, and circumstances surrounding drug overdose deaths. Furthermore, we will quantify demographic and regional variation in the types of substances involved in opioid overdose deaths. These objectives will inform prevention and mitigation efforts, including critical intervention points and changes in the drug supply. The database we create will not only allow us to achieve these objectives to address the escalating opioid crisis that involves fentanyl and stimulants but will lay the foundation for extensive future research.