Department of Mental Health, 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; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Drug Alcohol Depend. 2021 Jun 1;223:108700. doi: 10.1016/j.drugalcdep.2021.108700. Epub 2021 Apr 12.
The substances driving the overdose epidemic in the United States have changed over time. Since 2013, fentanyl-analogues have become the primary opioids driving the epidemic. Recently, polysubstance related deaths have come to the forefront of the epidemic. Therefore, we explored trends in polysubstance involvement in overdose fatalities in Maryland between 2003 and 2019.
We used records for the Maryland Office of the Chief Medical Examiner between 2003 and 2019. First, we assessed trends in the number of drugs (1, 2, 3+) involved in overdose fatalities over time. Then, we assessed linear and quadratic trends in nine substance categories using logistic regression.
Overtime, the proportion of overdose deaths involving one (ß=-0.28, p < 0.001) or two (ß=-0.14, p < 0.001) drugs decreased, while deaths involving three or more drugs increased (ß = 0.31, p < 0.001). The involvement of most drugs decreased over the study period. Only cocaine (linear ß=-0.08, p < 0.001; quadratic ß = 0.29, p < 0.001) and fentanyl (linear ß = 1.67, p < 0.001; quadratic ß = 0.75, p < 0.0001) showed significant increases over time. Post hoc analyses showed that cocaine involvement only increased in the presence of fentanyl (linear ß = 1.41, p < 0.001; quadratic ß = 0.70, p < 0.001) and decreased when fentanyl was not present (linear ß=-0.81, p < 0.001; quadratic ß=-0.31, p < 0.001).
Polysubstance involvement in overdose fatalities has become more common over time in Maryland. Most individual substances became less common over time, while cocaine and fentanyl involvement increased. Unintentional fentanyl consumption through contaminated cocaine may be an increasingly important driver of deaths in Maryland, indicating the importance of implementing widespread harm reduction programs, especially drug checking.
美国的药物过量流行所涉及的物质随时间而变化。自 2013 年以来，芬太尼类似物已成为推动该流行的主要阿片类药物。最近，多物质相关死亡已成为该流行的首要问题。因此，我们探讨了 2003 年至 2019 年期间马里兰州多物质参与药物过量致死的趋势。
我们使用了马里兰州首席法医办公室在 2003 年至 2019 年期间的记录。首先，我们评估了随着时间的推移，药物过量致死事件中涉及的药物数量（1、2、3+）的趋势。然后，我们使用逻辑回归评估了九个物质类别中线性和二次趋势。
随着时间的推移，涉及一种（ß=-0.28，p < 0.001）或两种（ß=-0.14，p < 0.001）药物的药物过量死亡比例下降，而涉及三种或更多药物的死亡比例上升（ß=0.31，p < 0.001）。研究期间，大多数药物的使用量都有所下降。只有可卡因（线性ß=-0.08，p < 0.001；二次ß=0.29，p < 0.001）和芬太尼（线性ß=1.67，p < 0.001；二次ß=0.75，p < 0.0001）显示出随时间的显著增加。事后分析表明，可卡因的使用仅在存在芬太尼时增加（线性ß=1.41，p < 0.001；二次ß=0.70，p < 0.001），而不存在芬太尼时则减少（线性ß=-0.81，p < 0.001；二次ß=-0.31，p < 0.001）。
马里兰州药物过量死亡中多物质的参与随时间的推移变得更加普遍。随着时间的推移，大多数物质的使用量减少，而可卡因和芬太尼的使用量增加。通过受污染的可卡因意外摄入芬太尼可能是马里兰州死亡人数增加的一个越来越重要的驱动因素，这表明实施广泛的减少伤害计划，特别是药物检测，非常重要。
