加利福尼亚州旧金山无家可归和住房不稳定的女性中的非致命性兴奋剂过量。
Non-fatal stimulant overdose among homeless and unstably housed women in San Francisco, California.
机构信息
Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
出版信息
Drug Alcohol Depend. 2021 Nov 1;228:109085. doi: 10.1016/j.drugalcdep.2021.109085. Epub 2021 Sep 22.
BACKGROUND
US rates of overdose deaths involving stimulants (e.g., cocaine or methamphetamine) have increased, but little is known about non-fatal stimulant overdoses, particularly among vulnerable populations. We characterized rates of non-fatal stimulant overdose identified outside of health care settings among women at high risk.
METHODS
Homeless and unstably housed women in San Francisco, California using stimulants were administered questionnaires on drug use and outcomes (stimulant overdose, health care utilization) monthly for six months. Based on pilot interviews, stimulant overdose during follow-up was defined as acute toxicity from stimulant use ("over-amping") resulting in "feeling sick, really scared, or like one's life may be in danger". Poisson regression estimated unadjusted incidence rate ratio (IRR) comparing participant characteristics.
RESULTS
We included 160 women (41% Black, 26% White, 15% Latina, median age 54 years) using crack cocaine (81%), methamphetamine (48%), and powdered cocaine (36%). Participants reported 67 non-fatal stimulant overdoses over 685 person-months of observation, a rate of 117.4 per 100 person-years (95% CI 85.8-160.5). Rates were higher among participants who were Latina vs. White (IRR 4.18 [1.60-10.94]), used methamphetamine (IRR 1.80 [0.96-3.38]), or used any stimulant daily/almost daily (IRR 2.63 [1.41-4.91]). Among women reporting stimulant overdose, 4% received emergency and 3% inpatient care for overdose of any drug.
CONCLUSIONS
Women in this setting, particularly those who used stimulants frequently or used methamphetamine, experienced high non-fatal stimulant overdose and rarely received health care for these events. Efforts should be made to increase awareness and reduce harms of stimulant toxicity in vulnerable populations.
背景
美国涉及兴奋剂（例如可卡因或甲基苯丙胺）的过量死亡人数有所增加，但对于非致命性兴奋剂过量的情况知之甚少，特别是在弱势群体中。我们描述了在加利福尼亚州旧金山，在卫生保健机构之外，高危女性中确定的非致命性兴奋剂过量的发生率。
方法
在加利福尼亚州旧金山，无家可归和住房不稳定的使用兴奋剂的女性每月接受一次关于药物使用和结果（兴奋剂过量，医疗保健使用）的问卷调查，为期六个月。根据试点访谈，随访期间的兴奋剂过量定义为因兴奋剂使用而导致的急性毒性（“过度兴奋”），从而“感到不适，非常害怕，或者感觉自己的生命可能处于危险之中”。泊松回归估计了比较参与者特征的未调整发病率比（IRR）。
结果
我们纳入了 160 名女性（41％为黑人，26％为白人，15％为拉丁裔，中位年龄为 54 岁），她们使用了可卡因（81％），甲基苯丙胺（48％）和可卡因粉末（36％）。在 685 个人月的观察中，参与者报告了 67 次非致命性兴奋剂过量，发生率为每 100 人年 117.4 次（95％CI 85.8-160.5）。与白人相比，拉丁裔参与者的发生率更高（IRR 4.18 [1.60-10.94]），使用甲基苯丙胺（IRR 1.80 [0.96-3.38]）或每天/几乎每天使用任何兴奋剂（IRR 2.63 [1.41-4.91]）。在报告兴奋剂过量的女性中，有 4％因任何药物的过量而接受了紧急护理，有 3％因过量而接受了住院治疗。
结论
在这种环境下的女性，特别是那些经常使用兴奋剂或使用甲基苯丙胺的女性，经历了高非致命性兴奋剂过量，但很少因这些事件而获得医疗保健。应努力提高弱势群体对兴奋剂毒性的认识并减少其危害。
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