Hoopsick Rachel A, Homish Gregory G, Leonard Kenneth E
12292 Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.
12292 Department of Community Health and Health Behavior, School of Public Health and Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA.
Public Health Rep. 2021 Mar-Apr;136(2):192-200. doi: 10.1177/0033354920968806. Epub 2020 Nov 19.
The types of opioids abused in the United States have changed from prescription opioids to heroin to fentanyl. However, the types of opioids abused may differ by demographic factors, especially among middle-aged adults. We examined national trends in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex.
Using 1999-2018 data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database, we examined overdose mortality rates per 100 000 population in 2018 among adults aged 45-64 that involved natural and semisynthetic opioids, heroin, synthetic opioids (excluding methadone), and methadone. We tested for significant differences in mortality rates by race/ethnicity and sex. We plotted drug-specific trends by race/ethnicity and sex from 1999 to 2018.
In 2018, non-Hispanic White adults had the highest rates per 100 000 population of natural and semisynthetic overdose mortality (men: 8.7; women: 7.9; < .001), and non-Hispanic Black adults had the highest rates of heroin (men: 17.7; women: 5.4; < .001) and synthetic opioid (men: 36.0; women: 11.2; < .001) overdose mortality. Men had significantly higher overdose mortality rates than women did for deaths involving natural and semisynthetic opioids, heroin, and synthetic opioids, but not methadone. From 1999 to 2018, mortality rates increased sharply for heroin and synthetic opioids, increased modestly for natural and semisynthetic opioids, and decreased for methadone. The greatest increases were among non-Hispanic Black men for heroin overdose (3.3 in 1999 to 17.7 in 2018) and synthetic opioid overdose (0.1 in 1999 to 36.0 in 2018).
Policy making should consider unique subgroup risks and alternative trajectories of opioid use other than people being prescribed opioids, developing opioid use disorder, subsequently moving to heroin, and then to fentanyl.
在美国，滥用的阿片类药物类型已从处方阿片类药物转变为海洛因再到芬太尼。然而，滥用的阿片类药物类型可能因人口统计学因素而异，尤其是在中年成年人中。我们按种族/族裔和性别研究了中年成年人阿片类药物过量死亡率的全国趋势。
利用疾病控制和预防中心的流行病学研究广泛在线数据（WONDER）数据库1999 - 2018年的数据，我们研究了2018年每10万45 - 64岁成年人中涉及天然和半合成阿片类药物、海洛因、合成阿片类药物（不包括美沙酮）和美沙酮的过量死亡率。我们测试了按种族/族裔和性别划分的死亡率的显著差异。我们绘制了1999年至2018年按种族/族裔和性别划分的特定药物趋势图。
2018年，每10万人口中，非西班牙裔白人成年人的天然和半合成阿片类药物过量死亡率最高（男性：8.7；女性：7.9；P <.001），非西班牙裔黑人成年人的海洛因（男性：17.7；女性：5.4；P <.001）和合成阿片类药物（男性：36.0；女性：11.2；P <.0）过量死亡率最高。在涉及天然和半合成阿片类药物、海洛因和合成阿片类药物的死亡中，男性的过量死亡率显著高于女性，但美沙酮情况并非如此。从1999年到2018年，海洛因和合成阿片类药物的死亡率急剧上升，天然和半合成阿片类药物的死亡率适度上升，美沙酮的死亡率下降。海洛因过量（从1999年的3.3到2018年的17.7）和合成阿片类药物过量（从1999年的0.1到2018年的36.0）死亡率上升幅度最大的是在非西班牙裔黑人男性中。
政策制定应考虑除了被开具阿片类药物处方、发展成阿片类药物使用障碍、随后转向海洛因、再转向芬太尼之外的独特亚组风险和阿片类药物使用的其他轨迹。
