Dasgupta Nabarun, Creppage Kathleen, Austin Anna, Ringwalt Christopher, Sanford Catherine, Proescholdbell Scott K
Injury Prevention Research Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 500, Campus Box 7505, Chapel Hill, NC 27599-7505, USA.
CDC/CSTE Applied Epidemiology Fellowship, N.C. Department of Health and Human Services, Injury Epidemiology and Surveillance Unit, Division of Public Health, 1915 Mail Service Center, Raleigh, NC 27699-1915, USA.
Drug Alcohol Depend. 2014 Dec 1;145:238-41. doi: 10.1016/j.drugalcdep.2014.10.005. Epub 2014 Oct 18.
In the United States, overdose mortality from controlled substances has increased over the last two decades, largely involving prescription opioid analgesics. Recently, there has been speculation on a transition away from prescription opioid use toward heroin, however the impact on overdose deaths has not been evaluated.
Time series study of North Carolina residents, 2007 through 2013. Monthly ratio of prescription opioid-to-heroin overdose deaths. Non-parametric local regression models used to ascertain temporal shifts from overdoses involving prescription opioids to heroin.
There were 4332 overdose deaths involving prescription opioids, and 455 involving heroin, including 44 where both were involved (total n = 4743). A gradual 6-year shift toward increasing heroin deaths was observed. In January, 2007, for one heroin death there were 16 opioid analgesic deaths; in December, 2013 there were 3 prescription opioid deaths for each heroin death. The transition to heroin appears to have started prior to the introduction of tamper-resistant opioid analgesics. The age of death among heroin decedents shifted toward younger adults. Most heroin and opioid analgesic deaths occurred in metropolitan areas, with little change between 2007 and 2013.
The observed increases in heroin overdose deaths can no longer be considered speculation. Deaths among younger adults were noted to have increased in particular, suggesting new directions for targeting interventions. More research beyond vital statistics is needed to understand the root causes of the shift from prescription opioids to heroin.
在美国，过去二十年来，受控物质过量致死率有所上升，主要涉及处方阿片类镇痛药。最近，有人猜测正从使用处方阿片类药物转向海洛因，但尚未评估这对过量死亡的影响。
对2007年至2013年北卡罗来纳州居民进行时间序列研究。计算处方阿片类药物过量死亡与海洛因过量死亡的月度比率。使用非参数局部回归模型确定从涉及处方阿片类药物的过量用药向海洛因过量用药的时间变化。
有4332例过量死亡涉及处方阿片类药物，455例涉及海洛因，其中44例两者都涉及（总数n = 4743）。观察到海洛因死亡人数呈6年逐渐上升趋势。2007年1月，每有1例海洛因死亡，就有16例阿片类镇痛药死亡；2013年12月，每例海洛因死亡对应3例处方阿片类药物死亡。向海洛因的转变似乎在引入抗篡改阿片类镇痛药之前就已开始。海洛因死亡者的年龄趋向于更年轻的成年人。大多数海洛因和阿片类镇痛药死亡发生在大都市地区，2007年至2013年期间变化不大。
观察到的海洛因过量死亡人数增加不再被视为猜测。尤其值得注意的是，年轻成年人中的死亡人数有所增加，这为有针对性的干预措施指明了新方向。需要开展更多超出生命统计数据范畴的研究，以了解从处方阿片类药物转向海洛因的根本原因。
