Department of Criminal Justice, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
Institute of Technology, Sligo, Ballinode, Ireland.
Forensic Sci Rev. 2022 Jan;34(1):43-70.
The US opioid crisis came in three waves - prescription opioids, heroin, and illicitly manufactured fentanyls - Centers for Disease Control and Prevention Centers for Disease Control and Prevention resulting in the deaths of nearly 500,000 people from 1996 to 2019. In 2009, drug overdose deaths exceeded those involving automobiles. Opioid overdose deaths contributed to the decrease in life expectancy for Americans from 78.8 to 78.5 during 2014 to 2017. The overprescribing of a schedule II prescription opioid was escalated by pharmaceutical companies promoting a growing belief that pain was an undertreated condition. In 2012, the number of opioid prescriptions peaked at 255 million and deaths exceeded 11,000 per year. The typical prescription opioid abuser was white, male, and 45-55 years of age. The hardest-hit states were in Appalachia and the Northeast. When an abuse-resistant formulation was introduced for OxyContin, the most prevalent prescription opioid, users turned to heroin. From the early 1980s, a new pizza delivery style of Mexican trafficking in black tar heroin infiltrated many of the same states hit hardest by prescription opioids. Heroin overdose deaths reached 14,495 in 2017. As heroin abuse increased in states supplied with black tar heroin, fentanyl-contaminated white powder heroin began to appear in the Northeast. Fentanyl was quickly followed by fentanyl analogs. While heroin deaths continued to escalate through 2017, they were soon overshadowed by fentanyl overdose deaths. Finally, prescription opioid and heroin overdose deaths started to decline in 2017, though fentanyl deaths continued to increase. In late 2019, it appeared that restrictions on transportation and travel due to the COVID-19 pandemic had resulted in decreased availability of illicit drugs, but by 2020 drug abuse had escalated in many countries. Globally, heroin was the primary opioid of abuse and only a few countries - including Canada, Germany, Austria, and Belgium - have experienced a significant increase in prescription opioids. However, illicitly manufactured fentanyls are a growing problem in North America, Europe, Australia, and Asia.
美国的阿片类药物危机经历了三个阶段——处方类阿片类药物、海洛因和非法制造的芬太尼，导致 1996 年至 2019 年间近 50 万人死亡。2009 年，药物过量死亡人数超过了涉及汽车的死亡人数。阿片类药物过量死亡导致 2014 年至 2017 年美国人的预期寿命从 78.8 岁降至 78.5 岁。制药公司大肆宣传，称疼痛是一种治疗不足的疾病，从而加剧了第二类处方类阿片药物的过度处方。2012 年，阿片类药物处方数量达到 2.55 亿张，每年死亡人数超过 1.1 万。典型的阿片类药物滥用者是白人、男性，年龄在 45 岁至 55 岁之间。受打击最严重的州在阿巴拉契亚地区和东北部。当最常见的处方类阿片类药物奥施康定时推出一种具有抗滥用特性的配方时，使用者转而使用海洛因。自 20 世纪 80 年代初以来，一种新的墨西哥贩毒方式——黑焦油海洛因的披萨送货模式渗透到许多受处方类阿片类药物影响最严重的州。2017 年，海洛因过量死亡人数达到 14495 人。随着海洛因滥用在供应黑焦油海洛因的州增加，芬太尼污染的白色粉末海洛因开始出现在东北部。芬太尼很快就被芬太尼类似物所取代。尽管海洛因死亡人数在 2017 年继续上升，但很快就被芬太尼过量死亡人数所掩盖。最后，2017 年处方类阿片类药物和海洛因过量死亡人数开始下降，尽管芬太尼死亡人数仍在继续增加。2019 年底，由于 COVID-19 大流行导致运输和旅行受限，非法毒品的供应似乎有所减少，但到 2020 年，许多国家的药物滥用问题都有所加剧。在全球范围内，海洛因是主要的阿片类药物滥用物，只有包括加拿大、德国、奥地利和比利时在内的少数几个国家报告称处方类阿片类药物的使用显著增加。然而，非法制造的芬太尼在北美、欧洲、澳大利亚和亚洲日益成为一个问题。
