Department of Family and Community Medicine, University of California, San Francisco, California, USA.
Curr Opin Psychiatry. 2021 Jul 1;34(4):344-350. doi: 10.1097/YCO.0000000000000717.
This review provides an update on recently published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences, and treatment.
Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both preceding and during the COVID-19 pandemic. Fentanyl-related overdose is rising in new geographic areas e.g. the western USA. Stimulant-related overdose is also increasing nationwide driven by methamphetamine and cocaine. Polysubstance use, e.g. the use of a stimulant along with an opioid is driving stimulant-related overdose. Other medical consequences of injection drug use are rising including HIV and hepatitis C infections. Medication approaches to treating opioid use disorder remain the standard of care and there are new promising pharmacological approaches to treating methamphetamine use disorder.
A 'fourth wave' of high mortality involving methamphetamine and cocaine use has been gathering force in the USA. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.
目的综述：本综述对近期发表的有关非法芬太尼兴起、过量风险、与其他物质（如兴奋剂）组合、后果和治疗的文献进行了更新。
最近发现：在美国，无论是在 COVID-19 大流行之前还是期间，非法合成阿片类药物（如芬太尼和芬太尼类似物）导致的过量用药都在持续上升。芬太尼相关的过量用药在新的地理区域（如美国西部）也在上升。由于冰毒和可卡因的使用，与兴奋剂相关的过量用药在全国范围内也呈上升趋势。多物质使用，例如兴奋剂与阿片类药物一起使用，正在导致与兴奋剂相关的过量用药。包括艾滋病毒和丙型肝炎感染在内的其他与注射毒品使用相关的医疗后果也在上升。药物治疗阿片类药物使用障碍仍然是护理的标准，并且有新的有前途的药物治疗冰毒使用障碍的方法。
总结：涉及冰毒和可卡因使用的高死亡率的“第四波”在美国逐渐加剧。非法芬太尼的供应和使用仍然是导致过量死亡的主要因素，目前与兴奋剂相关的死亡人数上升似乎与持续的阿片类药物流行交织在一起。
