识别非医疗使用阿片类药物者近期非致命性过量用药的途径：心理痛苦和未满足的心理健康需求如何增加过量用药风险？

Identifying pathways to recent non-fatal overdose among people who use opioids non-medically: How do psychological pain and unmet mental health need contribute to overdose risk?

机构信息

Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.

出版信息

Addict Behav. 2022 Apr;127:107215. doi: 10.1016/j.addbeh.2021.107215. Epub 2021 Dec 20.

DOI:10.1016/j.addbeh.2021.107215

PMID:34953432

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9169246/

Abstract

BACKGROUND

Significant associations exist between psychological pain, unmet mental health need, and frequency and severity of substance use among people who use drugs (PWUD), but no studies have analyzed the relationship of these variables to non-fatal overdose.

METHODS

We conducted a cross-sectional survey of people who used opioids non-medically in Baltimore, Maryland (n = 563) as part of a broader harm reduction-focused evaluation (PROMOTE). The outcome was self-reported recent (past 6 months) non-fatal overdose; exposures of interest were recent self-reported unmet mental health need, experiencing daily "long-lasting psychological or mental pain" (vs. < daily), and daily multi-opioid use (vs. none/one opioid used). Path analysis was used to model direct relationships between these variables, personal characteristics (race, gender, experiencing homelessness, drug injection) and overdose.

RESULTS

30% of the sample had experienced a recent non-fatal overdose, 46% reported unmet mental health need, 21% reported daily psychological pain, and 62% used multiple types of opioids daily. After adjusting for covariates, daily multi-opioid use (aOR = 1.78, p = 0.03) and unmet mental health need (aOR = 2.05, p = 0.01) were associated with direct, significant increased risk of recent overdose. Significant pathways associated with increased odds of unmet mental health need included woman gender (aOR = 2.23, p = 0.003) and daily psychological pain (aOR = 4.14, p = 0.002). In turn, unmet mental health need associated was with greater odds of daily multi-opioid use (aOR = 1.57, p = 0.05).

DISCUSSION

Unmet mental heath need and daily psychological pain are common experiences in this sample of PWUD. Unmet mental health need appears on several pathways to overdose and associated risk factors; improving access to mental healthcare for PWUD (particularly women) expressing need may be an important harm reduction measure.

摘要

背景

在使用毒品的人群（PWUD）中，心理痛苦、未满足的心理健康需求以及物质使用的频率和严重程度之间存在显著关联，但尚无研究分析这些变量与非致命性过量之间的关系。

方法

我们对马里兰州巴尔的摩市非医疗性使用阿片类药物的人进行了横断面调查（n=563），作为更广泛的以减少伤害为重点的评估（PROMOTE）的一部分。研究结果为自我报告的最近（过去 6 个月）非致命性过量；感兴趣的暴露因素是最近自我报告的未满足的心理健康需求、经历每天“持久的心理或精神痛苦”（与<每天）相比）和每天多阿片类药物使用（与无/一种阿片类药物使用相比）。路径分析用于对这些变量、个人特征（种族、性别、无家可归、药物注射）与过量之间的直接关系进行建模。

结果

该样本中有 30%的人最近经历了非致命性过量，46%的人报告未满足的心理健康需求，21%的人报告每天有心理痛苦，62%的人每天使用多种类型的阿片类药物。调整协变量后，每天多阿片类药物使用（OR=1.78，p=0.03）和未满足的心理健康需求（OR=2.05，p=0.01）与最近过量的直接显著增加风险相关。与未满足的心理健康需求相关的显著途径包括女性性别（OR=2.23，p=0.003）和每天的心理痛苦（OR=4.14，p=0.002）。反过来，未满足的心理健康需求与每天多阿片类药物使用的可能性更大相关（OR=1.57，p=0.05）。