Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
Eur Addict Res. 2021;27(6):399-412. doi: 10.1159/000516165. Epub 2021 May 7.
Between 2009 and 2018, the number of opioid-related deaths (ORDs) in Scotland showed a dramatic increase, whereas in England and Wales, a much lower increase in ORD was seen. This regional difference is remarkable, and the situation in Scotland is worrisome. Therefore, it is important to identify the drivers of ORD in Scotland.
A systematic literature review according to PRISMA guidelines was conducted to identify peer-reviewed studies about key drivers for the observed differences in ORDs between Scotland and England/Wales. In addition, non-peer-reviewed reports on nationwide statistical data were retrieved via Google and Google Scholar and analysed to quantify differences in ORD drivers between Scotland and England/Wales.
The systematic review identified some important drivers of ORD, but none of these studies provided direct or indirect comparisons of ORD drivers in Scotland and England/Wales. However, the reports with nationwide statistical data showed important differences in ORD drivers between Scotland and England/Wales, including a higher prevalence of people using opioids in a problematic way (PUOP), more polydrug use in people using drugs in a problematic way (PUDP), a higher age of PUDP, and lower treatment coverage and efficacy of PUDP in Scotland compared to England/Wales, but no regional differences in injecting drug use, incarceration/prison release without treatment, and social deprivation in PUDP.
It is concluded that the opioid crisis in Scotland is best explained by a combination of drivers, consisting of a higher population involvement in (problematic) opioid use (notably methadone), relatively more polydrug use (notably benzodiazepines and gabapentinoids), a steeper ageing of the PUOP population in the past 2 decades, and lower treatment coverage and efficacy in Scotland compared to England/Wales. The findings have important consequences for strategies to handle the opioid crisis in Scotland.
2009 年至 2018 年期间，苏格兰阿片类药物相关死亡人数（ORDs）急剧增加，而在英格兰和威尔士，ORD 仅出现较低幅度的增长。这种区域差异十分显著，苏格兰的情况令人担忧。因此，确定苏格兰 ORD 的驱动因素至关重要。
按照 PRISMA 指南进行了系统的文献回顾，以确定有关苏格兰和英格兰/威尔士之间观察到的 ORD 差异的主要驱动因素的同行评审研究。此外，通过谷歌和谷歌学术检索了关于全国统计数据的非同行评审报告，并进行了分析，以量化苏格兰和英格兰/威尔士之间 ORD 驱动因素的差异。
系统综述确定了一些 ORD 的重要驱动因素，但这些研究均未提供苏格兰和英格兰/威尔士之间 ORD 驱动因素的直接或间接比较。然而，具有全国统计数据的报告显示，苏格兰和英格兰/威尔士之间的 ORD 驱动因素存在重要差异，包括以问题方式使用阿片类药物的人数（PUOP）较高、以问题方式使用药物的人群中多药使用（PUDP）更多、PUDP 的年龄更高，以及苏格兰的 PUDP 治疗覆盖率和疗效较低，但在 PUDP 中，注射吸毒、监禁/出狱未治疗和社会贫困方面没有区域差异。
综上所述，苏格兰的阿片类药物危机最好用一系列驱动因素来解释，这些因素包括人口更多地参与（有问题的）阿片类药物使用（尤其是美沙酮）、相对更多的多药使用（尤其是苯二氮䓬类药物和加巴喷丁类药物）、过去 20 年来 PUOP 人群老龄化速度加快，以及苏格兰的治疗覆盖率和疗效均低于英格兰/威尔士。这些发现对苏格兰处理阿片类药物危机的策略具有重要意义。
