Department of Medicine, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
Massachusetts Department of Public Health, Boston, MA, USA.
Public Health Rep. 2019 Nov/Dec;134(6):667-674. doi: 10.1177/0033354919878429. Epub 2019 Oct 2.
Opioid-related overdoses are commonly attributed to prescription opioids. We examined data on opioid-related overdose decedents in Massachusetts. For each decedent, we determined which opioid medications had been prescribed and dispensed and which opioids were detected in postmortem medical examiner toxicology specimens.
Among opioid-related overdose decedents in Massachusetts during 2013-2015, we analyzed individually linked postmortem opioid toxicology reports and prescription drug monitoring program records to determine instances of overdose in which a decedent had a prescription active on the date of death for the opioid(s) detected in the toxicology report. We also calculated the proportion of overdoses for which prescribed opioid medications were not detected in decedents' toxicology reports.
Of 2916 decedents with complete toxicology reports, 1789 (61.4%) had heroin and 1322 (45.3%) had fentanyl detected in postmortem toxicology reports. Of the 491 (16.8%) decedents with ≥1 opioid prescription active on the date of death, prescribed opioids were commonly not detected in toxicology reports, specifically: buprenorphine (56 of 97; 57.7%), oxycodone (93 of 176; 52.8%), and methadone prescribed for opioid use disorder (36 of 112; 32.1%). Only 39 (1.3%) decedents had an active prescription for each opioid detected in toxicology reports on the date of death.
Linking overdose toxicology reports to prescription drug monitoring program records can help attribute overdoses to prescribed opioids, diverted prescription opioids, heroin, and illicitly made fentanyl.
阿片类药物相关过量通常归因于处方阿片类药物。我们检查了马萨诸塞州阿片类药物相关过量死亡者的数据。对于每一位死者，我们确定了哪些阿片类药物已被开处方和配药，以及哪些阿片类药物在法医毒理学标本中被检测到。
在 2013-2015 年期间，马萨诸塞州阿片类药物相关过量死亡者中，我们分析了单独链接的法医毒理学阿片类药物报告和处方药物监测计划记录，以确定在毒理学报告中检测到的阿片类药物死亡日期当天死者有处方活性的过量事件。我们还计算了在死者毒理学报告中未检测到处方阿片类药物的过量事件比例。
在有完整毒理学报告的 2916 位死者中，1789 位（61.4%）在死后毒理学报告中检测到海洛因，1322 位（45.3%）检测到芬太尼。在 491 位（16.8%）死亡日期当天至少有 1 种阿片类药物处方的死者中，毒理学报告中通常未检测到开处方的阿片类药物，具体为：丁丙诺啡（97 例中的 56 例；57.7%）、羟考酮（176 例中的 93 例；52.8%）和用于治疗阿片类药物使用障碍的美沙酮（112 例中的 36 例；32.1%）。只有 39 位（1.3%）死者在死亡日期当天的毒理学报告中检测到的每种阿片类药物都有有效的处方。
将过量毒理学报告与处方药物监测计划记录相关联有助于将过量归因于处方阿片类药物、被转移的处方阿片类药物、海洛因和非法制造的芬太尼。
