Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.
MMWR Morb Mortal Wkly Rep. 2019 Aug 30;68(34):737-744. doi: 10.15585/mmwr.mm6834a2.
From 2013 to 2017, the number of opioid-involved overdose deaths (opioid deaths) in the United States increased 90%, from 25,052 to 47,600.* This increase was primarily driven by substantial increases in deaths involving illicitly manufactured fentanyl (IMF) or fentanyl analogs mixed with heroin, sold as heroin, or pressed into counterfeit prescription pills (1-3). Methamphetamine-involved and cocaine-involved deaths that co-involved opioids also substantially increased from 2016 to 2017 (4). Provisional 2018 estimates of the number of opioid deaths suggest a small decrease from 2017. Investigating the extent to which decreases occurred broadly or were limited to a subset of opioid types (e.g., prescription opioids versus IMF) and drug combinations (e.g., IMF co-involving cocaine) can assist in targeting of intervention efforts. This report describes opioid deaths during January-June 2018 and changes from July-December 2017 in 25 of 32 states and the District of Columbia participating in CDC's State Unintentional Drug Overdose Reporting System (SUDORS).** Opioid deaths were analyzed by involvement (opioid determined by medical examiner or coroner to contribute to overdose death) of prescription or illicit opioids, as well as by the presence (detection of the drug in decedent) of co-occurring nonopioid drugs (cocaine, methamphetamine, and benzodiazepines). Three key findings emerged regarding changes in opioid deaths from July-December 2017 to January-June 2018. First, overall opioid deaths decreased 4.6%. Second, decreases occurred in prescription opioid deaths without co-involved illicit opioids and deaths involving non-IMF illicit synthetic opioids (fentanyl analogs and U-series drugs) (5). Third, IMF deaths, especially those with multiple illicit opioids and common nonopioids, increased. Consequently, IMF was involved in approximately two-thirds of opioid deaths during January-June 2018. Notably, during January-June 2018, 62.6% of all opioid deaths co-occurred with at least one common nonopioid drug. To maintain and accelerate reductions in opioid deaths, efforts to prevent IMF-involved deaths and address polysubstance misuse with opioids must be enhanced. Key interventions include broadening outreach to groups at high risk for IMF or fentanyl analog exposure and overdose. Improving linkage to and engagement in risk-reduction services and evidence-based treatment for persons with opioid and other substance use disorders with attention to polysubstance use or misuse is also needed.
从 2013 年到 2017 年，美国涉及阿片类药物的过量死亡人数（阿片类药物死亡人数）增加了 90%，从 25052 人增加到 47600 人。* 这一增长主要是由于涉及非法制造的芬太尼（IMF）或芬太尼类似物与海洛因混合、作为海洛因销售或压制成假冒处方药的死亡人数大幅增加所致（1-3）。从 2016 年到 2017 年，涉及甲基苯丙胺和可卡因的阿片类药物死亡人数也大幅增加（4）。2018 年阿片类药物死亡人数的临时估计数表明，与 2017 年相比略有下降。调查减少的程度是广泛发生还是仅限于特定类型的阿片类药物（例如，处方阿片类药物与 IMF）和药物组合（例如，IMF 与可卡因共同涉及）可以帮助针对干预措施进行目标定位。本报告描述了 2018 年 1 月至 6 月期间 32 个州和哥伦比亚特区中参与疾病预防控制中心国家非故意药物过量报告系统（SUDORS）的 25 个州的阿片类药物死亡情况和 2017 年 7 月至 12 月的变化。** 通过涉及处方或非法阿片类药物的（由法医或验尸官确定导致过量死亡的药物）以及同时存在（在死者中检测到的药物）的非阿片类药物（可卡因，甲基苯丙胺和苯二氮卓类药物）来分析阿片类药物死亡情况。从 2017 年 7 月至 12 月至 2018 年 1 月至 6 月，阿片类药物死亡人数的变化主要有三个发现。首先，阿片类药物总体死亡人数下降了 4.6%。其次，没有涉及非法阿片类药物的处方阿片类药物死亡人数和涉及非 IMF 合成阿片类药物（芬太尼类似物和 U 系列药物）的死亡人数有所减少（5）。第三，IMF 死亡人数，特别是涉及多种非法阿片类药物和常见非阿片类药物的死亡人数有所增加。因此，IMF 大约占 2018 年 1 月至 6 月期间阿片类药物死亡人数的三分之二。值得注意的是，在 2018 年 1 月至 6 月期间，所有阿片类药物死亡中有 62.6%至少与一种常见的非阿片类药物同时发生。为了保持并加速减少阿片类药物死亡人数，必须加强预防涉及 IMF 的死亡人数并解决阿片类药物与其他物质共同滥用的问题。关键干预措施包括扩大针对 IMF 或芬太尼类似物暴露和过量风险高的群体的外联活动。还需要改善与患有阿片类药物和其他物质使用障碍的人建立联系并参与减少风险的服务，并提供基于证据的治疗，同时注意多物质使用或滥用。
