Parker Maria A, Anthony James C
Michigan State University, United States.
Michigan State University, United States.
Drug Alcohol Depend. 2014 May 1;138:225-8. doi: 10.1016/j.drugalcdep.2014.02.005. Epub 2014 Feb 17.
Many pre-clinical and clinical researchers do not appreciate the recent decline in United States (US) population-level incidence of crack-cocaine smoking. At present, no more than about 200 young people start using crack-cocaine each day. Ten years ago, the corresponding estimated daily rate was 1000. This short communication looks into these trends, surrounding evidence on this important public health topic, and checks whether duration-reducing treatment interventions might be responsible, versus selected alternatives.
Via analyses of standardized computer-assisted self-interview data from the US National Surveys on Drug Use and Health (NSDUH, 2002-2011; n>500,000), we evaluated change in incidence estimates, perceived difficulty to acquire crack, risk of using cocaine, treatment entries, and persistence once crack use has started.
We draw attention to a marked overall decline in year-specific incidence rates for crack-cocaine smoking from 2002 to 2011, especially 2007-2011. There is some variation in estimates of difficulty to acquire crack (p<0.001) and observed risk of using cocaine among 'at risk' susceptibles (p<0.001), but no appreciable shifts in duration of crack smoking among active users (p>0.05) or in proportion of crack users receiving treatment (p>0.05).
Changing epidemiology of crack-cocaine smoking may rest largely on reductions in newly incident use with no major direct effects due to US cocaine treatment, incarceration, or interdiction. Concurrently, we see quite modest declines in survey-based estimates of cocaine-attributed perceived risk and cocaine availability. As such, we posit that no specific US agency should claim it is 'riding to glory' on the descending limb of this epidemic curve.
许多临床前和临床研究人员并未意识到美国人口层面吸食快克可卡因的发生率近期有所下降。目前，每天开始吸食快克可卡因的年轻人不超过200人。十年前，相应的估计日发生率为1000人。本简短通讯探讨了这些趋势、围绕这一重要公共卫生话题的相关证据，并考察了减少使用时长的治疗干预措施是否可能是导致这种情况的原因，而非其他选定的因素。
通过分析来自美国全国药物使用和健康调查（NSDUH，2002 - 2011年；n>500,000）的标准化计算机辅助自我访谈数据，我们评估了发生率估计值的变化、获取快克可卡因的感知难度、使用可卡因的风险、治疗登记情况以及开始吸食快克可卡因后的持续情况。
我们注意到2002年至2011年期间，尤其是2007年至2011年，吸食快克可卡因的逐年发生率显著整体下降。获取快克可卡因的难度估计值存在一些差异（p<0.001），且在“高危”易感人群中观察到的使用可卡因风险也存在差异（p<0.001），但活跃使用者中吸食快克可卡因的时长没有明显变化（p>0.05），接受治疗的快克可卡因使用者比例也没有明显变化（p>0.05）。
吸食快克可卡因的流行病学变化可能主要归因于新发病例使用的减少，而美国的可卡因治疗、监禁或缉毒行动没有产生重大直接影响。同时，我们发现基于调查的可卡因归因感知风险和可卡因可获得性估计值仅有适度下降。因此，我们认为没有哪个美国特定机构应该宣称自己在这一流行曲线的下降阶段“功成名就”。
