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

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，1999-2010年间，阿片类镇痛药过量死亡在女性和男性中分别急剧增加了400%和265%以上。2009年，美国阿片类药物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问题与白宫将药物引起的发病率和死亡率降低15%的目标是一致的。旧金山历来是阿片类药物使用和相关发病率的主要城市，在改善获得激动剂维持服务和在全市范围内实施纳洛酮（用于逆转阿片类药物过量的短效阿片类拮抗剂）后，与海洛因相关的死亡率急剧下降。然而，阿片类镇痛药死亡率的激增抵消了这一死亡率优势。由于没有监测阿片类药物过量指标的当地系统，我们仍然对“谁”死于阿片类镇痛药知之甚少。此外，目前尚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浓度之间的关系。为了有效应对阿片类药物过量，关键是要制定方法来识别和监测过量趋势，并评估干预措施的有效性。我们建议对从加利福尼亚州电子死亡报告系统（EDRS）收集的阿片类药物过量死亡数据进行二次分析，与公共物质使用治疗记录数据库的数据相匹配，并对旧金山公共卫生部附属的安全网医疗保健系统中所有患者的图表进行审查。我们将使用泊松回归模型评估2010-2012年旧金山总体和社区阿片类药物过量死亡的年度趋势（目标1）。我们还将利用毒理学和医疗及药物使用治疗记录描述旧金山县阿片类药物过量死亡的人口统计学和临床特征（目标2）。W探讨了阿片类药物过量死亡、铺纳洛酮分布和铺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项目数据作为分母来计算阿片类药物过量死亡率，并进行生态分析，以研究阿片类药物过量死亡与社区因素之间的关系。本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，并加强干预措施以降低阿片类药物过量死亡率。

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.