Dept. of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Dept. of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA.
Int J Drug Policy. 2022 Feb;100:103525. doi: 10.1016/j.drugpo.2021.103525. Epub 2021 Nov 24.
Illicitly manufactured fentanyl (IMF) is increasing in international drug supply chains, and IMF-related opioid overdose deaths are rising in North America. Hospitalizations among patients with opioid use disorder (OUD) are also rising; and, hospitalized patients are at increased risk of overdose and death following hospital discharge. Hospitalization is a key opportunity to engage patients with OUD. Addiction consult services (ACS) can provide effective treatment for patients hospitalized with OUD. This study aims to estimate the effect of increasing IMF contamination on drug-related death among patients hospitalized with OUD, and simulate the role of ACS expansion to mitigate these effects.
We used a Markov model to mirror care systems for adult patients hospitalized with OUD in Oregon, from the time of hospital admission through 12-months post-discharge, and simulated patients through modeled care systems to evaluate the expansion of Addiction Consult Services in the context of increasing IMF in the drug supply.
In a simulated cohort of 10,000 patients, we estimate that 537 patients would die from drug-related causes within 12-months of hospital discharge. In the context of increased IMF in the drug supply, this estimate increased to 913. ACS referral at baseline was 4%; increasing ACS referral to accommodate 10%, 50%, or 100% of hospitalized OUD patients in the state reduces drug-related deaths to 904, 849, and 780, respectively. The number needed to treat for ACS to avoid one drug-related death in the context of increased IMF was 73.
Hospitals should expand interventions to help reduce IMF-related opioid overdoses, including through implementation of ACS. In the context of rising IMF-related deaths, ACS expansion could help connect patients to treatment, offer harm reduction interventions, or both, which can help reduce the risk of opioid-related death.
非法制造的芬太尼（IMF）在国际毒品供应链中不断增加，北美因 IMF 相关阿片类药物过量死亡的人数也在上升。患有阿片类药物使用障碍（OUD）的患者住院率也在上升；并且，住院患者在出院后有更高的过量用药和死亡风险。住院是接触患有 OUD 患者的关键机会。成瘾咨询服务（ACS）可以为因 OUD 住院的患者提供有效的治疗。本研究旨在评估增加 IMF 污染对因 OUD 住院患者药物相关死亡的影响，并模拟 ACS 扩张以减轻这些影响的作用。
我们使用马尔可夫模型来模拟俄勒冈州因 OUD 住院的成年患者的护理系统，从住院到出院后 12 个月，通过模拟患者在模型化的护理系统中评估在药物供应中增加 IMF 的情况下，扩大成瘾咨询服务的作用。
在模拟的 10000 名患者队列中，我们估计在出院后 12 个月内，有 537 名患者会因药物相关原因死亡。在药物供应中 IMF 增加的情况下，这一估计值增加到 913 人。ACS 转诊率在基线时为 4%；将 ACS 转诊率提高到 10%、50%或 100%，以适应该州 10000 名 OUD 住院患者中的 10%、50%或 100%，可将药物相关死亡人数分别降低至 904、849 和 780。在增加 IMF 的情况下，为避免一人因 ACS 相关药物死亡所需的治疗人数为 73 人。
医院应扩大干预措施，以帮助减少与 IMF 相关的阿片类药物过量，包括通过实施 ACS。在与 IMF 相关的死亡人数上升的情况下，ACS 扩张可以帮助患者与治疗建立联系，提供减少伤害的干预措施，或者两者兼而有之，这可以帮助降低阿片类药物相关死亡的风险。
