Somerville Nicholas J, O'Donnell Julie, Gladden R Matthew, Zibbell Jon E, Green Traci C, Younkin Morgan, Ruiz Sarah, Babakhanlou-Chase Hermik, Chan Miranda, Callis Barry P, Kuramoto-Crawford Janet, Nields Henry M, Walley Alexander Y
MMWR Morb Mortal Wkly Rep. 2017 Apr 14;66(14):382-386. doi: 10.15585/mmwr.mm6614a2.
Opioid overdose deaths in Massachusetts increased 150% from 2012 to 2015 (1). The proportion of opioid overdose deaths in the state involving fentanyl, a synthetic, short-acting opioid with 50-100 times the potency of morphine, increased from 32% during 2013-2014 to 74% in the first half of 2016 (1-3). In April 2015, the Drug Enforcement Agency (DEA) and CDC reported an increase in law enforcement fentanyl seizures in Massachusetts, much of which was believed to be illicitly manufactured fentanyl (IMF) (4). To guide overdose prevention and response activities, in April 2016, the Massachusetts Department of Public Health and the Office of the Chief Medical Examiner collaborated with CDC to investigate the characteristics of fentanyl overdose in three Massachusetts counties with high opioid overdose death rates. In these counties, medical examiner charts of opioid overdose decedents who died during October 1, 2014-March 31, 2015 were reviewed, and during April 2016, interviews were conducted with persons who used illicit opioids and witnessed or experienced an opioid overdose. Approximately two thirds of opioid overdose decedents tested positive for fentanyl on postmortem toxicology. Evidence for rapid progression of fentanyl overdose was common among both fatal and nonfatal overdoses. A majority of interview respondents reported successfully using multiple doses of naloxone, the antidote to opioid overdose, to reverse suspected fentanyl overdoses. Expanding and enhancing existing opioid overdose education and prevention programs to include fentanyl-specific messaging and practices could help public health authorities mitigate adverse effects associated with overdoses, especially in communities affected by IMF.
2012年至2015年期间，马萨诸塞州的阿片类药物过量致死人数增加了150%（1）。该州涉及芬太尼的阿片类药物过量致死比例从2013 - 2014年期间的32%增至2016年上半年的74%。芬太尼是一种合成短效阿片类药物，效力为吗啡的50至100倍（1 - 3）。2015年4月，美国缉毒局（DEA）和疾病预防控制中心（CDC）报告称，马萨诸塞州执法部门查获的芬太尼有所增加，其中大部分被认为是非法制造的芬太尼（IMF）（4）。为指导过量用药预防和应对活动，2016年4月，马萨诸塞州公共卫生部和首席法医办公室与疾病预防控制中心合作，对马萨诸塞州阿片类药物过量死亡率高的三个县的芬太尼过量用药特征展开调查。在这些县，对2014年10月1日至2015年3月31日期间死于阿片类药物过量的死者的法医图表进行了审查，并于2016年4月对使用非法阿片类药物且目睹或经历过阿片类药物过量的人员进行了访谈。大约三分之二的阿片类药物过量死亡者在尸检毒理学检测中芬太尼呈阳性。芬太尼过量用药快速进展的证据在致命和非致命过量用药案例中都很常见。大多数受访者报告称成功使用多剂纳洛酮（阿片类药物过量的解毒剂）逆转了疑似芬太尼过量用药情况。扩大并加强现有的阿片类药物过量用药教育和预防项目，使其包含针对芬太尼的信息和做法，有助于公共卫生当局减轻与过量用药相关的不良影响，尤其是在受非法制造芬太尼影响的社区。
