Andrew King, Daniel Foley, and Cynthia Aaron are with Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI. Andrew King and Cynthia Aaron are also with Michigan Regional Poison Control Center, Detroit, MI. Cynthia Arfken is with Wayne State University School of Medicine, Department of Psychiatry and Behavioral Neuroscience. Lokman Sung and Leigh Hlavaty are with Wayne County Medical Examiner Office, Detroit, MI.
Am J Public Health. 2019 Feb;109(2):300-302. doi: 10.2105/AJPH.2018.304814. Epub 2018 Dec 20.
To identify opioids associated with a spike in opioid-related mortality in Wayne County, Michigan, from July 2016 through February 2017.
We reviewed records from the Wayne County Medical Examiner's Office of 645 people who died because of accidental nonmedically prescribed opioid overdoses from July 2015 through July 2017. We analyzed basic demographics, locations of death, and all opioid toxicology results. Decedents who died in hospitals were excluded.
Of the 645 people who died because of nonmedically prescribed opioid overdoses, 65% were male and 63% were White, with an average age of 43 years. Carfentanil was detected in 129 (20%) cases. During the 8-month mortality spike, carfentanil was detected in 114 of 419 cases (average = 27.2%; range = 6.4%-45.2%). Substances most frequently detected with carfentanil included morphine (57%), 6-monoacetylmorphine (38%), fentanyl (43%), norfentanyl (33%), tetrahydrocannabinol (34%), and cocaine (29%).
The Wayne County spike in mortality temporally corresponded with the detection of carfentanil and a proportional increase in opioid overdose deaths with detectable carfentanil. Public Health Implications. The abrupt decrease in carfentanil-detected mortality coincided with an announcement indicating an impending ban on fentanyl analogs from China, which suggests that source control is an effective countermeasure.
确定密歇根州韦恩县 2016 年 7 月至 2017 年 2 月期间与阿片类药物相关死亡人数增加相关的阿片类药物。
我们回顾了 2015 年 7 月至 2017 年 7 月期间因意外非医疗处方阿片类药物过量而死亡的韦恩县法医办公室的 645 人的记录。我们分析了基本人口统计学、死亡地点和所有阿片类药物毒理学结果。排除在医院死亡的死者。
在因非医疗处方阿片类药物过量而死亡的 645 人中，65%为男性，63%为白人，平均年龄为 43 岁。在 129 例（20%）中检测到卡芬太尼。在 8 个月的死亡率飙升期间，在 419 例中的 114 例（平均为 27.2%；范围为 6.4%-45.2%）中检测到卡芬太尼。最常与卡芬太尼一起检测到的物质包括吗啡（57%）、6-单乙酰吗啡（38%）、芬太尼（43%）、去甲芬太尼（33%）、四氢大麻酚（34%）和可卡因（29%）。
韦恩县的死亡率飙升与卡芬太尼的检测以及可检测到卡芬太尼的阿片类药物过量死亡人数的比例增加有关。公共卫生意义。卡芬太尼检测死亡率的急剧下降恰逢中国即将禁止芬太尼类似物的公告，这表明来源控制是一种有效的对策。
