Office of Research and Evaluation, Federal Bureau of Prisons, 320 First St. N.W., Washington, D.C. 20534.
J Clin Psychiatry. 2010 Apr;71(4):491-6. doi: 10.4088/JCP.09m05567blu.
Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes.
In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program.
Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug.
Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered.
1999 年至 2006 年间，美国非故意药物过量致死率上升了 120%。本研究旨在确定西弗吉尼亚州处方药过量死亡病例中心理疾病（药物滥用的风险因素之一）和慢性疼痛的流行程度，并确定导致死亡的精神类药物是用于治疗精神疾病还是出于非医疗目的。
2007 年，我们从西弗吉尼亚州首席法医办公室记录的 2006 年所有非故意处方药过量死亡案例中提取了与精神疾病、疼痛和导致死亡的药物相关的数据。从该州的处方药物监测项目中获得了死者的处方记录。
分别有 42.7%和 56.6%的 295 名死者有精神疾病和疼痛病史。48.8%的死亡与精神类药物有关，其中涉及苯二氮䓬类药物 36.6%。导致死亡的苯二氮䓬类药物与精神疾病无关（调整后的优势比[OR] = 1.1；95%置信区间[CI]，0.6-1.8），而其他所有精神类药物均有关联（OR = 3.9；95% CI，2.0-7.6）。在有苯二氮䓬类药物参与的死者中，46.3%没有该药物的处方。
精神疾病可能导致与死亡相关的物质滥用。临床医生在开具阿片类药物时应筛查精神疾病，并建议将心理治疗作为药物治疗的辅助手段或替代手段。苯二氮䓬类药物可能被非医疗用途滥用，而非作为精神类药物，这反映了药物滥用。可以考虑将苯二氮䓬类药物的处方限制为 30 天供应量且不得续方。
