Morizio Kate M, Baum Regan A, Dugan Adam, Martin Julia E, Bailey Abby M
Department of Pharmacy, Banner University Medical Center at the University of Arizona, Tucson, Arizona.
Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky.
Pharmacotherapy. 2017 Jul;37(7):781-790. doi: 10.1002/phar.1902. Epub 2017 Feb 27.
To characterize the differences between patients who had heroin and nonheroin opioid overdoses and to determine whether there were any significant differences in their management with regard to the naloxone use.
Retrospective cohort study.
Large academic medical center.
A total of 923 patients admitted to the medical center who were identified for overdose by heroin or other opiate-related narcotics between January 2010 and September 2015; 480 patients experienced a nonheroin opioid overdose event, and 443 patients experienced a heroin overdose event.
Patients presenting with heroin overdose tended to be younger and male, with higher rates of hepatitis C virus (HCV) infection compared with those presenting with nonheroin opioid overdose (p<0.05). Patients in the heroin group were also more likely to have a previous overdose event, history of injection drug use, and history of prescription opioid abuse compared with the nonheroin group (p<0.05). Those presenting with heroin overdose were more likely to receive naloxone in the prehospital setting (p<0.05) but were less likely to receive naloxone once admitted (p<0.05). Patients with nonheroin opioid overdoses required more continuous infusions of naloxone (p<0.05) and admission to the intensive care unit (p<0.05). Of all 923 patients, 178 (19.3%) had a repeat admission for any reason, and 70 (7.6%) were readmitted over the course of the study period for another overdose event with the same drug. The proportion of patients presenting with a heroin overdose steadily increased from 2010-2015; the number of patients presenting to the emergency department with nonheroin opioid overdoses steadily decreased. As rates of heroin overdose increased each year, the incidence of HCV infection increased dramatically.
This study indicates that the incidence of heroin overdoses has significantly increased over the last several years, and the rates of HCV infection 4-fold since the start of the study period. Patients admitted for nonheroin opioid overdose were more likely to be admitted to the hospital and intensive care unit compared with those admitted for heroin overdose. The rise in overdose events only further illustrates a gap in our understanding of the cycle of addiction, drug abuse, and overdose events.
描述海洛因过量与非海洛因阿片类药物过量患者之间的差异，并确定在纳洛酮使用方面的治疗是否存在显著差异。
回顾性队列研究。
大型学术医疗中心。
2010年1月至2015年9月期间因海洛因或其他阿片类相关麻醉品过量而被送至该医疗中心的923名患者；480名患者经历了非海洛因阿片类药物过量事件，443名患者经历了海洛因过量事件。
与非海洛因阿片类药物过量患者相比，海洛因过量患者往往更年轻且为男性，丙型肝炎病毒（HCV）感染率更高（p<0.05）。与非海洛因组相比，海洛因组患者既往有过量用药事件、注射吸毒史和处方阿片类药物滥用史的可能性也更高（p<0.05）。海洛因过量患者在院前环境中更有可能接受纳洛酮治疗（p<0.05），但入院后接受纳洛酮治疗的可能性较小（p<0.05）。非海洛因阿片类药物过量患者需要更多次持续输注纳洛酮（p<0.05），并入住重症监护病房（p<0.05）。在所有923名患者中，178名（19.3%）因任何原因再次入院，70名（7.6%）在研究期间因同一药物再次过量事件再次入院。2010 - 2015年期间，海洛因过量患者的比例稳步上升；因非海洛因阿片类药物过量到急诊科就诊的患者数量稳步下降。随着海洛因过量发生率逐年上升，HCV感染率急剧增加。
本研究表明，在过去几年中，海洛因过量的发生率显著增加，自研究开始以来，HCV感染率增加了4倍。与海洛因过量患者相比，因非海洛因阿片类药物过量入院的患者更有可能入住医院和重症监护病房。过量事件的增加进一步说明了我们在理解成瘾、药物滥用和过量事件循环方面存在差距。
