Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
Drug Alcohol Depend. 2021 Mar 1;220:108513. doi: 10.1016/j.drugalcdep.2021.108513. Epub 2021 Jan 9.
Nonfatal overdose contributes to high morbidity and is among the strongest proxies for the occurrence of overdose fatality - the leading cause of death among those who use opioids. In Ukraine, a majority of people who inject drugs (PWID) use opioids, but little is known about the relationship between drug market characteristics, nonfatal overdose (NFOD) prevalence, and risk factors for NFOD.
We used cross-sectional respondent-driven sampling (RDS) data to explore the variability of recent (past 12 months) NFOD among PWID across Ukrainian cities and associations with individual factors. The population-averaged -cross-sectional associations were estimated and compared using generalized linear models for the binary outcome (NFOD vs. not) with robust variance estimates.
Recent self-reported NFOD varied between 1% and 14 % across Ukrainian cities. In adjusted analyses, overdose was associated with fewer years of injecting drugs; a higher number of types of drugs used in the past 12 months; using desomorphine, methadone, tramadol, heroin, amphetamine-type drugs or cocaine within past 12 months; using alcohol daily or weekly; recent drug treatment; and history of incarceration. Buying drugs or their ingredients through "stashes" (i.e., drugs secretly hidden in various places) and the perception of drug price increase were associated with higher odds of reporting NFOD.
The identified risk factors underscore the importance of evidence-based prevention efforts, such as scaling-up opioid agonist therapy, providing naloxone in the community and upon prison release, targeting those most likely to witness overdose and sharing overdose prevention strategies with them, and continuous monitoring of trends and contributing factors.
非致命性药物过量是导致高发病率的原因之一，也是药物过量致死的最强预测指标之一，而药物过量致死是阿片类药物使用者的主要死因。在乌克兰，大多数注射吸毒者（PWID）使用阿片类药物，但人们对药物市场特征、非致命性药物过量（NFOD）的流行程度以及 NFOD 的危险因素之间的关系知之甚少。
我们使用了横断面应答驱动抽样（RDS）数据，以探讨乌克兰各城市的近期（过去 12 个月）PWID 的 NFOD 变异情况，以及与个体因素的关联。使用广义线性模型估计和比较了人口平均 - 横断面关联，该模型用于二项结果（NFOD 与非 NFOD），并采用稳健方差估计。
在乌克兰各城市，最近报告的 NFOD 比例在 1%到 14%之间有所不同。在调整分析中，药物过量与吸毒年限较少、过去 12 个月使用的毒品种类较多、过去 12 个月内使用过右美沙芬、美沙酮、曲马多、海洛因、苯丙胺类药物或可卡因、每天或每周使用酒精、最近接受过药物治疗和有入狱史有关。通过“藏匿处”（即毒品秘密藏在各种地方）购买毒品或其成分，以及认为毒品价格上涨，与报告 NFOD 的几率较高有关。
确定的危险因素强调了基于证据的预防措施的重要性，例如扩大阿片类激动剂治疗、在社区和出狱时提供纳洛酮、针对最有可能目睹药物过量的人并与他们分享药物过量预防策略，以及持续监测趋势和相关因素。
