School of Public Affairs, 1420 Austin Bluffs Parkway, University of Colorado, Colorado Springs, United States.
School of Public Affairs, 1420 Austin Bluffs Parkway, University of Colorado, Colorado Springs, United States.
Int J Drug Policy. 2020 Apr;78:102718. doi: 10.1016/j.drugpo.2020.102718. Epub 2020 Mar 19.
Drug overdose is a significant public health problem, yet little is known about racial/ethnic differences in drug overdose rates and/or in responses to a drug overdose following naloxone administration. This paper examines differences in rates of survivorship, response, revival and administration of naloxone by race and ethnicity among those who experienced a drug overdose in Pennsylvania between January 1, 2018 and December 31, 2019. Spatio-temporal variations in drug overdose locations were examined to facilitate understanding of service development, planning, and delivery of effective treatment need.
Ten thousand two hundred and ninety drug overdose incidents were analyzed from the Pennsylvania Overdose Information Network (ODIN). The ODIN is a centralized repository that contains information on drug overdoses victims including age, gender and race/ethnicity, naloxone administrations and survivorship, drug(s) suspected of causing the overdose, victim outcomes (e.g. hospitalizations and arrests) and average naloxone dosage per victim. Between group differences were tested using χ2 -tests of independence. Multivariate logistic regression was used to estimate the predicted probability of survivorship according to victim characteristics. All statistical analyses and mapping were performed using the R statistical programming environment.
About eighty-seven percent of drug overdose response victims were white, and seventy-one percent were between the ages of 20-39. White females were more likely to receive an overdose response compared to black or Hispanic females. A non-opioid was indicated more frequently in overdoses involving black victims compared to either whites or Latinos. Latinos and blacks were more likely to survive a drug overdose. However, following naloxone administration, no racial or ethnic differences in survivorship were noted. Differences in responsiveness to naloxone and transitions to care following the drug overdose event were also found. Finally, overdoses among Blacks and Latinos demonstrated a stronger spatial patterning across counties compared to whites.
This study found a significant, disparate impact of race/ethnicity on fatal drug overdoses when naloxone is not administered. Further, individuals who were administered naloxone and subsequently received medical care in a hospital experienced lower drug-related mortality, suggesting that first responders are critical intervention points for individuals in need of medical treatment following a drug overdose. However, while naloxone administration is a necessary first step in the recovery process, longitudinal pathways towards treatment are critical to stem the drug overdose crisis.
药物过量是一个严重的公共卫生问题，但人们对药物过量率以及纳洛酮给药后药物过量的反应方面的种族/民族差异知之甚少。本文研究了宾夕法尼亚州 2018 年 1 月 1 日至 2019 年 12 月 31 日期间经历药物过量的人群中，种族和民族之间的生存率、反应、复苏和纳洛酮给药的差异。检查了药物过量地点的时空变化，以促进了解服务的发展、规划和提供有效的治疗需求。
从宾夕法尼亚州过量信息网络 (ODIN) 分析了 1290 起药物过量事件。ODIN 是一个集中式存储库，其中包含药物过量受害者的信息，包括年龄、性别和种族/民族、纳洛酮给药和生存率、疑似导致过量的药物、受害者结局（例如住院和逮捕）和每个受害者的平均纳洛酮剂量。使用 χ2-独立性检验测试组间差异。使用多变量逻辑回归根据受害者特征估计生存率的预测概率。所有统计分析和制图均使用 R 统计编程环境进行。
大约 87%的药物过量反应受害者是白人，71%的人年龄在 20-39 岁之间。白人女性比黑人或西班牙裔女性更有可能接受过量反应。与白人或拉丁裔相比，黑人受害者的药物过量中更常出现非阿片类药物。拉丁裔和黑人更有可能从药物过量中存活下来。然而，在接受纳洛酮治疗后，没有观察到种族或民族在生存率方面的差异。还发现了对纳洛酮的反应性以及药物过量事件后向护理的过渡方面的差异。最后，与白人相比，黑人和拉丁裔的药物过量在县之间表现出更强的空间模式。
本研究发现，在未给予纳洛酮时，种族/民族对致命药物过量有显著的、不同的影响。此外，接受纳洛酮治疗并随后在医院接受医疗护理的个体的药物相关死亡率较低，这表明急救人员是需要医疗治疗的个体的关键干预点药物过量。然而，虽然纳洛酮给药是康复过程中的必要第一步，但纵向治疗途径对于遏制药物过量危机至关重要。
