Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.
JAMA Netw Open. 2020 Apr 1;3(4):e202361. doi: 10.1001/jamanetworkopen.2020.2361.
The use of benzodiazepines or alcohol together with opioids increases overdose risk, but characterization of co-involvement by predominant opioid subtype is incomplete to date. Understanding the use of respiratory depressants in opioid overdose deaths (OODs) is important for prevention efforts and policy making.
To assess the prevalence and number of alcohol- or benzodiazepine-involved OODs by opioid subtypes in the United States from 1999 to 2017.
This repeated cross-sectional analysis used data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database of all opioid-involved poisoning deaths from January 1, 1999, to December 31, 2017, for the United States. State-level binge drinking prevalence rates for 2015 to 2017 were obtained from the Behavior Risk Factor Surveillance System of the Centers for Disease Control and Prevention, and benzodiazepine prescribing rates for 2012 (most recent available data) were obtained from IMS Health, a commercial database. Data were analyzed from July 10, 2018, to May 16, 2019.
Prevalence of alcohol or benzodiazepine co-involvement for all OODs and by opioid subtype, nationally and by state.
From 1999 to 2017, 399 230 poisoning deaths involved opioids, of which 263 601 (66.0%) were male, and 204 560 (51.2%) were aged 35 to 54 years. Alcohol co-involvement for all opioid overdose deaths increased nonlinearly from 12.4% in 1999 to 14.7% in 2017. By opioid subtype, deaths involving heroin and synthetic opioids (eg, fentanyl; excluding methadone) had the highest alcohol co-involvement at 15.5% and 14.9%, respectively, in 2017. Benzodiazepine co-involvement in all OODs increased nonlinearly from 8.7% in 1999 to 21.0% in 2017. Benzodiazepines were present in 33.1% of prescription OODs and 17.1% of synthetic OODs in 2017. State-level rates of binge drinking were significantly correlated with alcohol co-involvement in all OODs (r = 0.34; P = .02). State benzodiazepine prescribing rates were significantly correlated with benzodiazepine co-involvement in all OODs (r = 0.57; P < .001).
This study found that alcohol and benzodiazepine co-involvement in opioid-involved overdose deaths was common, varied by opioid subtype, and was associated with state-level binge drinking and benzodiazepine prescribing rates. These results may inform state policy initiatives in harm reduction and overdose prevention efforts.
苯二氮䓬类药物或酒精与阿片类药物同时使用会增加过量风险，但迄今为止，对主要阿片类药物亚型共同涉及的特征描述还不完整。了解阿片类药物过量死亡（OOD）中呼吸抑制剂的使用情况对于预防工作和政策制定非常重要。
评估 1999 年至 2017 年美国按阿片类药物亚型划分的酒精或苯二氮䓬类药物共同涉及的 OOD 发生率和数量。
本重复横断面分析使用了疾病控制和预防中心广域在线流行病学研究（WONDER）数据库中 1999 年 1 月 1 日至 2017 年 12 月 31 日期间所有涉及阿片类药物的中毒死亡数据，来自美国。2015 年至 2017 年的州级狂欢饮酒流行率数据来自疾病控制和预防中心的行为风险因素监测系统，2012 年（可获得的最新数据）的苯二氮䓬类药物处方率数据来自 IMS Health，这是一个商业数据库。数据分析于 2018 年 7 月 10 日至 2019 年 5 月 16 日进行。
全国范围内和各州范围内所有 OOD 以及按阿片类药物亚型划分的酒精或苯二氮䓬类药物共同涉及的发生率。
1999 年至 2017 年，涉及阿片类药物的中毒死亡 399230 例，其中 263601 例（66.0%）为男性，204560 例（51.2%）年龄在 35 至 54 岁之间。所有阿片类药物过量死亡中酒精共同涉及的比例呈非线性增加，从 1999 年的 12.4%增加到 2017 年的 14.7%。按阿片类药物亚型划分，涉及海洛因和合成阿片类药物（如芬太尼；不包括美沙酮）的死亡酒精共同涉及的比例最高，分别为 2017 年的 15.5%和 14.9%。所有 OOD 中苯二氮䓬类药物共同涉及的比例呈非线性增加，从 1999 年的 8.7%增加到 2017 年的 21.0%。2017 年，处方 OOD 中有 33.1%和合成 OOD 中有 17.1%存在苯二氮䓬类药物。州级狂欢饮酒流行率与所有 OOD 中的酒精共同涉及率呈显著相关（r=0.34；P=0.02）。州级苯二氮䓬类药物处方率与所有 OOD 中的苯二氮䓬类药物共同涉及率呈显著相关（r=0.57；P<0.001）。
本研究发现，阿片类药物过量死亡中酒精和苯二氮䓬类药物共同涉及的情况很常见，按阿片类药物亚型有所不同，且与州级狂欢饮酒流行率和苯二氮䓬类药物处方率有关。这些结果可能为减少伤害和预防过量的州级政策倡议提供信息。
Zotero 插件
