Yarborough Bobbi Jo H, Stumbo Scott P, Janoff Shannon L, Yarborough Micah T, McCarty Dennis, Chilcoat Howard D, Coplan Paul M, Green Carla A
Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
Department of Public Health & Preventive Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Hill Road, CB 669, Portland, OR 97239, USA.
Drug Alcohol Depend. 2016 Oct 1;167:49-56. doi: 10.1016/j.drugalcdep.2016.07.024. Epub 2016 Aug 1.
Opioid abuse and misuse are significant public health issues. The CDC estimated 72% of pharmaceutical-related overdose deaths in the US in 2012 involved opioids. While studies of opioid overdoses have identified sociodemographic characteristics, agents used, administration routes, and medication sources associated with overdoses, we know less about the context and life circumstances of the people who experience these events.
We analyzed interviews (n=87) with survivors of opioid overdoses or family members of decedents. Individuals experiencing overdoses were members of a large integrated health system. Using ICD codes for opioid overdoses and poisonings, we identified participants from five purposefully derived pools of health-plan members who had: 1) prescriptions for OxyContin(®) or single-ingredient sustained-release oxycodone, 2) oxycodone single-ingredient immediate release, 3) other long-acting opioids, 4) other short-acting opioids, or 5) no active opioid prescriptions.
Individuals who experienced opioid overdoses abused and misused multiple medications/drugs; experienced dose-related miscommunications or medication-taking errors; had mental health and/or substance use conditions; reported chronic pain; or had unstable resources or family/social support. Many had combinations of these risks. Most events involved polysubstance use, often including benzodiazepines. Accidental overdoses were commonly the result of abuse or misuse, some in response to inadequately treated chronic pain or, less commonly, medication-related mistakes. Suicide attempts were frequently triggered by consecutive negative life events.
To identify people at greater risk of opioid overdose, efforts should focus on screening for prescribed and illicit polysubstance use, impaired cognition, and changes in life circumstances, psychosocial risks/supports, and pain control.
阿片类药物的滥用和误用是重大的公共卫生问题。美国疾病控制与预防中心（CDC）估计，2012年美国72%与药物相关的过量用药死亡涉及阿片类药物。虽然对阿片类药物过量用药的研究已经确定了与过量用药相关的社会人口统计学特征、使用的药物、给药途径和药物来源，但我们对经历这些事件的人的背景和生活状况了解较少。
我们分析了对阿片类药物过量用药幸存者或死者家属的访谈（n = 87）。经历过量用药的个体是一个大型综合医疗系统的成员。使用阿片类药物过量用药和中毒的国际疾病分类（ICD）编码，我们从五个有针对性选取的健康计划成员组中识别出参与者，这些成员有：1）奥施康定（OxyContin®）或单成分缓释羟考酮的处方，2）单成分速释羟考酮，3）其他长效阿片类药物，4）其他短效阿片类药物，或5）无活性阿片类药物处方。
经历阿片类药物过量用药的个体滥用和误用多种药物；经历与剂量相关的沟通失误或用药错误；有心理健康和/或物质使用问题；报告有慢性疼痛；或资源不稳定或家庭/社会支持不足。许多人存在这些风险的组合。大多数事件涉及多药合用，通常包括苯二氮䓬类药物。意外过量用药通常是滥用或误用的结果，有些是对未得到充分治疗的慢性疼痛的反应，较少见的是与药物相关的错误。自杀企图经常由连续的负面生活事件引发。
为了识别阿片类药物过量用药风险较高的人群，应努力筛查处方和非法多药合用、认知障碍以及生活状况、心理社会风险/支持和疼痛控制方面的变化。
