Ho Joel, DeBeck Kora, Milloy M-J, Dong Huiru, Wood Evan, Kerr Thomas, Hayashi Kanna
a Department of Medicine , University of Manitoba, Health Sciences Centre , Winnipeg , Canada.
b British Columbia Centre on Substance Use , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.
Am J Drug Alcohol Abuse. 2018;44(3):368-377. doi: 10.1080/00952990.2017.1376678. Epub 2017 Oct 19.
Nonmedical use of prescription opioid and illicit opioid has been increasing at an alarming rate in North America over the past decade.
We sought to examine the temporal trends and correlates of the availability of illicit and prescription opioids among people who inject drugs (PWID) in Vancouver, Canada.
Data were derived from three prospective cohort studies of PWID in Vancouver between 2010 and 2014. In semiannual interviews, participants reported the availability of five sets of illicit and prescription opioids: (1) heroin; (2) Percocet (oxycodone/acetaminophen), Vicodin (hydrocodone/acetaminophen), or Demerol (meperidine); (3) Dilaudid (hydromorphone); (4) Morphine; (5) oxycontin/OxyNEO (controlled-release oxycodone). We defined perceived availability as immediate (e.g., available within 10 minutes) versus no availability/available after 10 minutes. The trend and correlation of immediate availability were identified by multivariable generalized estimating equations logistic regression.
Among 1584 participants, of which 564 (35.6%) were female, the immediate availability of all illicit and prescribed opioids (except for oxycontin/OxyNEO) increased over time, independent of potential confounders. The Adjusted Odds Ratios of immediate availability associated with every calendar year increase were between 1.09 (95% confidence interval 1.05-1.12) (morphine and Dilaudid) and 1.13 (95% confidence interval 1.09-1.17) (Percocet/Vicodin/Demerol) (all p-values <0.05).
The availability of most prescription opioids had continued to increase in recent years among our sample of PWID in Vancouver. Concurrent increases in the availability of heroin were also observed, raising concerns regarding combination of both illicit and prescription opioid use among PWID that could potentially increase the risk of overdose.
在过去十年中，北美地区处方阿片类药物的非医疗使用和非法阿片类药物的使用一直在以惊人的速度增长。
我们试图研究加拿大温哥华注射吸毒者（PWID）中非法和处方阿片类药物可得性的时间趋势及其相关因素。
数据来自2010年至2014年期间在温哥华对注射吸毒者进行的三项前瞻性队列研究。在半年一次的访谈中，参与者报告了五组非法和处方阿片类药物的可得性：（1）海洛因；（2）羟考酮/对乙酰氨基酚片（Percocet）、氢可酮/对乙酰氨基酚片（Vicodin）或哌替啶（Demerol）；（3）氢吗啡酮（Dilaudid）；（4）吗啡；（5）奥施康定/奥施康定控释片（OxyNEO，控释羟考酮）。我们将感知可得性定义为即时可得（例如，10分钟内可得）与不可得/10分钟后可得。通过多变量广义估计方程逻辑回归确定即时可得性的趋势和相关性。
在1584名参与者中，564名（35.6%）为女性，所有非法和处方阿片类药物（奥施康定/奥施康定控释片除外）的即时可得性随时间增加，不受潜在混杂因素影响。与每一个日历年增加相关的即时可得性调整比值比在1.09（95%置信区间1.05 - 1.12）（吗啡和氢吗啡酮）至1.13（95%置信区间1.09 - 1.17）（羟考酮/对乙酰氨基酚片/氢可酮/对乙酰氨基酚片/哌替啶）之间（所有p值<0.05）。
近年来，在我们温哥华注射吸毒者样本中，大多数处方阿片类药物的可得性持续增加。同时也观察到海洛因可得性的增加，这引发了对注射吸毒者非法和处方阿片类药物联合使用的担忧，这可能会增加过量用药的风险。
