MMWR Morb Mortal Wkly Rep. 2016 Dec 30;65(50-51):1445-1452. doi: 10.15585/mmwr.mm655051e1.
The U.S. opioid epidemic is continuing, and drug overdose deaths nearly tripled during 1999-2014. Among 47,055 drug overdose deaths that occurred in 2014 in the United States, 28,647 (60.9%) involved an opioid (1). Illicit opioids are contributing to the increase in opioid overdose deaths (2,3). In an effort to target prevention strategies to address the rapidly changing epidemic, CDC examined overall drug overdose death rates during 2010-2015 and opioid overdose death rates during 2014-2015 by subcategories (natural/semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone).* Rates were stratified by demographics, region, and by 28 states with high quality reporting on death certificates of specific drugs involved in overdose deaths. During 2015, drug overdoses accounted for 52,404 U.S. deaths, including 33,091 (63.1%) that involved an opioid. There has been progress in preventing methadone deaths, and death rates declined by 9.1%. However, rates of deaths involving other opioids, specifically heroin and synthetic opioids other than methadone (likely driven primarily by illicitly manufactured fentanyl) (2,3), increased sharply overall and across many states. A multifaceted, collaborative public health and law enforcement approach is urgently needed. Response efforts include implementing the CDC Guideline for Prescribing Opioids for Chronic Pain (4), improving access to and use of prescription drug monitoring programs, enhancing naloxone distribution and other harm reduction approaches, increasing opioid use disorder treatment capacity, improving linkage into treatment, and supporting law enforcement strategies to reduce the illicit opioid supply.
美国阿片类药物泛滥问题仍在持续,1999 年至 2014 年期间,药物过量致死人数几乎增加了两倍。2014 年,美国共有 47055 例药物过量致死,其中 28647 例(60.9%)涉及阿片类药物(1)。非法阿片类药物是导致阿片类药物过量致死人数增加的原因之一(2,3)。为了针对不断变化的疫情制定预防策略,疾病预防控制中心(CDC)按药物过量死亡的亚类(天然/半合成阿片类药物、美沙酮、海洛因和非美沙酮的合成阿片类药物)检查了 2010 年至 2015 年期间的总体药物过量致死率和 2014 年至 2015 年期间的阿片类药物过量致死率*。根据人口统计学、地区以及 28 个有高质量报告的州对涉及药物过量死亡的特定药物的死亡证明进行分层。2015 年,药物过量导致 52404 名美国人死亡,其中 33091 例(63.1%)涉及阿片类药物。在预防美沙酮死亡方面取得了进展,死亡率下降了 9.1%。然而,涉及其他阿片类药物(特别是海洛因和非美沙酮的合成阿片类药物)的死亡率总体上和许多州都急剧上升,这可能主要是由非法制造的芬太尼驱动的(2,3)。迫切需要采取多方面的、协作性的公共卫生和执法措施。应对措施包括实施疾病预防控制中心(CDC)的《慢性疼痛阿片类药物处方指南》(4),改善处方药物监测计划的获取和使用,加强纳洛酮的分发和其他减少伤害的方法,增加阿片类药物使用障碍治疗能力,改善治疗衔接,以及支持执法战略以减少非法阿片类药物供应。