利用法医案例叙述来改进阿片类药物过量监测。
Using medical examiner case narratives to improve opioid overdose surveillance.
机构信息
Division of General Internal Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
Substance Use Research Unit, San Francisco Department of Public Health, San Francisco, CA, USA.
出版信息
Int J Drug Policy. 2018 Apr;54:35-42. doi: 10.1016/j.drugpo.2017.12.017. Epub 2018 Jan 30.
BACKGROUND
Current opioid overdose mortality surveillance methods do not capture the complexity of the overdose epidemic. Most rely on death certificates, which may underestimate both opioid analgesic and heroin deaths. Categorizing deaths using other characteristics from the death record including route of drug administration may provide useful information to design and evaluate overdose prevention interventions.
METHODS
We reviewed California Electronic Death Reporting System records and San Francisco Office of the Chief Medical Examiner (OCME) toxicology reports and investigative case narratives for all unintentional opioid overdose deaths in San Francisco County from 2006 to 2012. We chose this time period because it encompassed a period of evolution in local opioid use patterns and expansion of overdose prevention efforts. We created a classification system for heroin-related and injection-related opioid overdose deaths and compared demographic, death scene, and toxicology characteristics among these groups.
RESULTS
We identified 816 unintentional opioid overdose deaths. One hundred fifty-two (19%) were standard heroin deaths, as designated by the OCME or by the presence of 6-monoacetylmorphine. An "expanded" classification for heroin deaths incorporating information from toxicology reports and case narratives added 20 additional heroin deaths (13% increase), accounting for 21% of all opioid deaths. Two hundred five deaths (25%) were injection-related, 60% of which were attributed to heroin. A combined classification of expanded heroin and injection-related deaths accounted for 31% of opioid overdose deaths during this period.
CONCLUSIONS
Using additional sources of information to classify opioid overdose cases resulted in a modest increase in the count of heroin overdose deaths but identified a substantial number of non-heroin injection-related opioid analgesic deaths. Including the route of administration in the characterization of opioid overdose deaths can identify meaningful subgroups of opioid users to enhance surveillance efforts and inform targeted public health programming including overdose prevention programs.
背景
目前的阿片类药物过量死亡监测方法无法捕捉到过量流行的复杂性。大多数方法依赖于死亡证明，这可能会低估阿片类镇痛药和海洛因死亡人数。使用死亡记录中的其他特征（包括给药途径）对死亡进行分类可能会为设计和评估过量预防干预措施提供有用信息。
方法
我们回顾了加利福尼亚州电子死亡报告系统记录和旧金山首席法医办公室（OCME）毒理学报告以及旧金山县 2006 年至 2012 年所有非故意阿片类药物过量死亡的调查案例叙述。我们选择这段时间是因为它涵盖了当地阿片类药物使用模式演变和过量预防工作扩大的时期。我们为与海洛因相关和与注射相关的阿片类药物过量死亡创建了一个分类系统，并比较了这些组之间的人口统计学、死亡现场和毒理学特征。
结果
我们确定了 816 例非故意阿片类药物过量死亡。152 例（19%）是标准海洛因死亡，由 OCME 指定或存在 6-单乙酰吗啡。通过将毒理学报告和案例叙述中的信息纳入其中，对海洛因死亡进行了“扩展”分类，增加了 20 例额外的海洛因死亡（增加 13%），占所有阿片类药物死亡的 21%。205 例（25%）与注射有关，其中 60%归因于海洛因。扩展的海洛因和与注射相关的死亡联合分类占该时期阿片类药物过量死亡的 31%。
结论
使用额外的信息来源对阿片类药物过量病例进行分类，导致海洛因过量死亡人数略有增加，但确定了大量非海洛因注射相关的阿片类药物镇痛药死亡人数。在阿片类药物过量死亡的特征描述中包括给药途径，可以识别出有意义的阿片类药物使用者亚组，以加强监测工作并为有针对性的公共卫生计划提供信息，包括过量预防计划。
Zotero 插件