Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Chapel Hill, NC, 27514, United States.
Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Chapel Hill, NC, 27514, United States; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC, 27599-7445, United States.
Drug Alcohol Depend. 2021 Feb 1;219:108504. doi: 10.1016/j.drugalcdep.2020.108504. Epub 2021 Jan 2.
Polysubstance involvement is increasing among fatal drug overdoses. However, little is known about the epidemiology of polysubstance drug overdoses. This paper describes emerging trends in unintentional polysubstance overdose deaths in North Carolina (NC) and examines associations with individual and community factors.
Using 2009-2018 NC death certificate data, we identified unintentional drug overdose deaths and commonly involved substances (opioids, stimulants, benzodiazepines, alcohol, and antiepileptics). We examined polysubstance combinations, comparing opioid and non-opioid involved deaths. We examined individual level correlates from death certificate data and community level correlates from the American Community Survey and Robert Wood Johnson Foundation County Health Rankings to quantify associations.
From 2009-2018, 53 % of opioid and 19 % of non-opioid overdose deaths involved multiple substances. During this period, polysubstance overdose death increased dramatically, from 2.9 to 12.1 per 100,000 persons, with the greatest increases among drug combinations involving stimulants. The most common polysubstance combinations were: opioids and stimulants (12.1 % of overdose deaths); opioids and benzodiazepines (9.0 %); opioids and alcohol (5.1 %); opioids, stimulants, and benzodiazepines (3.1 %); and opioids, benzodiazepines, and antiepileptics (2.2 %). Compared to overdoses involving opioids alone, overdoses involving combinations of opioids, stimulants, and benzodiazepines involved younger individuals (53.7 % in 15-34 years of age vs. 40.7 %). Men comprised two-thirds of overdoses involving opioids alone, however, overdoses involving opioids, benzodiazepines, and antiepileptics were predominantly among women (60.6 %).
Polysubstance involvement has increased among overdose deaths in NC. These findings can be used to inform public health interventions addressing polysubstance deaths and associated individual and community level factors.
在致命药物过量中，多种物质滥用的情况正在增加。然而，对于多种物质药物过量的流行病学情况，人们知之甚少。本文描述了北卡罗来纳州（NC）非故意多种物质药物过量死亡的新趋势，并研究了与个体和社区因素的关系。
利用 2009-2018 年 NC 死亡证明数据，我们确定了非故意药物过量死亡和常见涉及的物质（阿片类药物、兴奋剂、苯二氮䓬类药物、酒精和抗癫痫药）。我们检查了阿片类药物和非阿片类药物涉及的死亡之间的多种物质组合。我们从死亡证明数据中检查了个体水平的相关因素，从美国社区调查和罗伯特伍德约翰逊基金会县卫生排名中检查了社区水平的相关因素，以量化关联。
从 2009 年至 2018 年，53%的阿片类药物和 19%的非阿片类药物过量死亡涉及多种物质。在此期间，多种物质药物过量死亡急剧增加，从每 10 万人 2.9 例增加到 12.1 例，涉及兴奋剂的药物组合增加最多。最常见的多种物质组合包括：阿片类药物和兴奋剂（12.1%的过量死亡）；阿片类药物和苯二氮䓬类药物（9.0%）；阿片类药物和酒精（5.1%）；阿片类药物、兴奋剂和苯二氮䓬类药物（3.1%）；以及阿片类药物、苯二氮䓬类药物和抗癫痫药（2.2%）。与单独涉及阿片类药物的过量相比，涉及阿片类药物、兴奋剂和苯二氮䓬类药物的过量涉及更年轻的个体（53.7%为 15-34 岁，而 40.7%为 35-44 岁）。男性占单独涉及阿片类药物的过量的三分之二，但涉及阿片类药物、苯二氮䓬类药物和抗癫痫药的过量主要是女性（60.6%）。
在 NC 的过量死亡中，多种物质的参与有所增加。这些发现可用于为解决多种物质死亡及其相关的个体和社区因素的公共卫生干预提供信息。
