Division of Unintentional Injury Prevention.
Division of Violence Prevention, National Center for Injury Prevention and Control.
Pain Med. 2018 Mar 1;19(3):511-523. doi: 10.1093/pm/pnx015.
This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl.
This cross-sectional investigation comprised all ODs reviewed by Rhode Island's Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME's charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases. Decedents whose cause of death involved illicit fentanyl (N = 69) were compared with decedents whose causes of death did not involve fentanyl (other drug decedents; N = 467).
Illicit-fentanyl decedents were younger than other drug decedents (P = 0.005). While more other-drug decedents than illicit fentanyl decedents had postmortem toxicological evidence of consuming heroin (31.9% vs 19.8%, P < 0.001) and various pharmaceutical substances (P = 0.002-0.027), third party reports indicated more recent heroin use among illicit fentanyl decedents (62.3% vs 45.6%, P = 0.002). Approximately 35% of decedents filled an opioid prescription within 90 days of death; of these, one-third had a mean daily dosage greater than 100 morphine milligram equivalents (MME/day). Most decedents' opioid prescriptions were filled at one to two dispensers (83.9%) and written by one to two prescribers (75.8%). Notably, 29.2% of illicit fentanyl and 10.5% of other drug decedents filled prescriptions for buprenorphine, which is used to treat opioid use disorders.
Illicit-fentanyl deaths frequently involved other illicit drugs (e.g., cocaine, heroin). The proportion of all decedents acquiring greater than 100 MME/day prescription dosages written and/or filled by few prescribers and dispensers is concerning. To protect patients, prescribers and dispensers should review PMP records and substance abuse history prior to providing opioids.
本研究旨在确定罗德岛药物过量死亡者（因过量使用芬太尼而导致死亡）的社会人口统计学、物质使用以及多位阿片类药物开方者和配药者风险因素。
本横断面调查包括罗德岛州法医办公室（OSME）在 2012 年 1 月至 2014 年 3 月期间审查的所有药物过量死亡者。从 OSME 的图表、死亡证明、毒理学报告和处方监测计划（PMP）数据库中提取了 536 名死者的数据。将死因涉及非法芬太尼（N=69）的死者与死因不涉及芬太尼（其他药物死亡者；N=467）的死者进行比较。
非法芬太尼死亡者比其他药物死亡者年轻（P=0.005）。虽然更多的其他药物死亡者有死后毒理学证据表明曾摄入海洛因（31.9%比 19.8%，P<0.001）和各种药物（P=0.002-0.027），但第三方报告表明非法芬太尼死亡者最近使用海洛因的情况更多（62.3%比 45.6%，P=0.002）。约 35%的死者在死亡后 90 天内填写了阿片类药物处方；其中，三分之一的人的平均日剂量大于 100 吗啡毫克当量（MME/天）。大多数死者的阿片类药物处方在 1 到 2 个配药者（83.9%）和 1 到 2 个开方者（75.8%）处开具。值得注意的是，29.2%的非法芬太尼和 10.5%的其他药物死亡者开出了丁丙诺啡的处方，丁丙诺啡用于治疗阿片类药物使用障碍。
非法芬太尼死亡者经常涉及其他非法药物（例如可卡因、海洛因）。所有死者中，获得由少数开方者和配药者开具/配药的日剂量大于 100 MME 的处方的比例令人担忧。为了保护患者，开方者和配药者应在提供阿片类药物之前审查 PMP 记录和药物滥用史。
