Stoecker William V, Bosworth K Taylor, Rottnek Fred
MSMA member since 1984, practices at S&A Technologies and The Dermatology Center, Rolla, Missouri, and the Department of Dermatology, University of Missouri-Columbia Health Sciences Center, Columbia, Missouri.
Departments of Biological Sciences and Psychological Science, Missouri University of Science and Technology, Rolla, Missouri.
Mo Med. 2020 Jul-Aug;117(4):362-369.
Recently, Missouri has followed an overall upward trend in opioid overdose deaths. In 2018, Missouri was the state with the largest absolute and percentage increase in opioid-related overdose fatality rates per capita over the previous year (18.3% and 3.1/100,000). This increase occurred despite an overall decrease in U.S. opioid-related death rates in the same period. This report identifies illicitly manufactured fentanyl (IMF) (and analogues) as the drug most responsible for this rise in opioid deaths in Missouri, with stimulant overdoses (primarily from methamphetamine) in second place. Within Missouri, we find the areas where opioid deaths are highest: St. Louis and the city's fringe areas, following the national trend for high rates in fringe areas. Based on reports from CDC Wonder data, county medical examiners, law enforcement agencies, and drug addiction prevention agencies, we conclude that IMF and related synthetic opioids arriving from China are primarily responsible for fatal narcotic overdoses in Missouri. Despite the COVID-19 disruption of fentanyl manufacturing and distribution centers in and around Wuhan, China early in the pandemic, preliminary 2020 data from medical examiners' offices show an upswing in opioid deaths, an indicator that Chinese fentanyl producers have restored the supply chain.
最近，密苏里州的阿片类药物过量死亡人数呈总体上升趋势。2018年，密苏里州是人均阿片类药物相关过量死亡率较上一年绝对增幅和百分比增幅最大的州（分别为18.3%和3.1/10万）。尽管同期美国阿片类药物相关死亡率总体下降，但这一增长仍出现了。本报告确定非法制造的芬太尼（IMF）（及其类似物）是密苏里州阿片类药物死亡人数上升的最主要原因，兴奋剂过量（主要来自甲基苯丙胺）位居第二。在密苏里州内，我们发现阿片类药物死亡人数最多的地区：圣路易斯及其周边地区，这与全国边缘地区高死亡率的趋势一致。根据美国疾病控制与预防中心（CDC）Wonder数据、县法医办公室、执法机构和药物成瘾预防机构的报告，我们得出结论，从中国运来的IMF及相关合成阿片类药物是密苏里州致命麻醉品过量的主要原因。尽管在疫情早期，新冠疫情对中国武汉及其周边地区的芬太尼制造和分销中心造成了干扰，但法医办公室2020年的初步数据显示阿片类药物死亡人数有所上升，这表明中国芬太尼生产商已恢复了供应链。
