Washington University, Department of Psychiatry, Campus Box 8134, 660 S. Euclid Avenue, St. Louis, MO 63110 USA.
Washington University, Department of Psychiatry, Campus Box 8134, 660 S. Euclid Avenue, St. Louis, MO 63110 USA.
Drug Alcohol Depend. 2018 Dec 1;193:14-20. doi: 10.1016/j.drugalcdep.2018.08.029. Epub 2018 Oct 10.
BACKGROUND/AIMS: Recent supply-side efforts enacted to curb the opioid epidemic have had both positive (i.e., prescription opioid abuse is on the decline) and negative outcomes (i.e., shifts to other drugs). Given methamphetamine is notably increasing in use across the United States, we sought to understand whether use of methamphetamine has increased among opioid users and whether there is an association between these two epidemics.
Patients (N = 13,521) entering drug treatment programs across the United States completed an anonymous survey of drug use patterns from 2011 to 2017. A subset of these patients (N = 300) was also interviewed to add context and expand on the structured survey.
Past month use of methamphetamine significantly increased among treatment-seeking opioid users (+82.6%, p < .001), from 18.8% in 2011 to 34.2% in 2017. The Western region had the greatest increase in past month methamphetamine use (+202.4%, p < 0.001) and the highest prevalence rate in 2017 (63.0%). Significant increases (p < .001) in methamphetamine use were seen among males (+81.8%), females (+97.8%), whites (+100.6%), urban residents (+123.0%) and rural residents (+93.7%).
Our studies show that there has been a marked increase in the past month use of methamphetamine in individuals with a primary indication of opioid use disorder. Qualitative data indicated that methamphetamine served as an opioid substitute, provided a synergistic high, and balanced out the effects of opioids so one could function "normally". Our data suggest that, at least to some extent, efforts limiting access to prescription opioids may be associated with an increase in the use of methamphetamine.
背景/目的：为了遏制阿片类药物泛滥，最近采取了一些供应方措施，这些措施既有积极的结果（即处方类阿片滥用有所减少），也有消极的结果（即转而使用其他药物）。鉴于在美国，冰毒的使用明显增加，我们试图了解阿片类药物使用者中使用冰毒的情况是否有所增加，以及这两种流行疾病之间是否存在关联。
美国各地的药物治疗项目中的患者（N=13521）完成了一项关于药物使用模式的匿名调查，时间跨度为 2011 年至 2017 年。其中一小部分患者（N=300）接受了访谈，以增加背景信息并扩展结构化调查的内容。
在寻求治疗的阿片类药物使用者中，过去一个月使用冰毒的比例显著增加（增加 82.6%，p<0.001），从 2011 年的 18.8%增加到 2017 年的 34.2%。西部地区过去一个月使用冰毒的比例增幅最大（增加 202.4%，p<0.001），2017 年的冰毒使用率最高（63.0%）。男性（增加 81.8%）、女性（增加 97.8%）、白人（增加 100.6%）、城市居民（增加 123.0%）和农村居民（增加 93.7%）的冰毒使用量均显著增加（p<0.001）。
我们的研究表明，过去一个月内，患有主要阿片类药物使用障碍的个体中，冰毒的使用明显增加。定性数据表明，冰毒被用作阿片类药物的替代品，提供了协同作用的快感，平衡了阿片类药物的效果，使患者能够“正常”运作。我们的数据表明，至少在某种程度上，限制处方类阿片类药物获取的措施可能与冰毒使用的增加有关。
