Nicholas B. King is with the Biomedical Ethics Unit and the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec. Veronique Fraser is with the Biomedical Ethics Unit, McGill University. Constantina Boikos, Robin Richardson, and Sam Harper are with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University.
Am J Public Health. 2014 Aug;104(8):e32-42. doi: 10.2105/AJPH.2014.301966. Epub 2014 Jun 12.
We review evidence of determinants contributing to increased opioid-related mortality in the United States and Canada between 1990 and 2013. We identified 17 determinants of opioid-related mortality and mortality increases that we classified into 3 categories: prescriber behavior, user behavior and characteristics, and environmental and systemic determinants. These determinants operate independently but interact in complex ways that vary according to geography and population, making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult. Preventing additional opioid-related mortality will likely require interventions that address multiple determinants and are tailored to specific locations and populations.
我们回顾了 1990 年至 2013 年期间导致美国和加拿大阿片类药物相关死亡率上升的决定因素的证据。我们确定了 17 个与阿片类药物相关的死亡率和死亡率上升的决定因素，并将其分为 3 类：处方行为、使用者行为和特征以及环境和系统决定因素。这些决定因素独立运作，但以复杂的方式相互作用，因地理位置和人口而异，因此从单一研究中进行推断是不可取的。该领域的研究人员面临着重大的方法学困难；我们综述中的大多数研究都是生态或观察性的，缺乏对照组或混杂因素的调整；因此，很难进行因果推断。防止更多的阿片类药物相关死亡可能需要采取干预措施，以解决多个决定因素，并针对特定地点和人群进行调整。
