National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States of America.
Office of National Drug Control Policy, High Intensity Drug Trafficking Area, Washington, DC, United States of America.
PLoS One. 2022 Mar 9;17(3):e0263893. doi: 10.1371/journal.pone.0263893. eCollection 2022.
The Covid-19 pandemic and its accompanying public-health orders (PHOs) have led to (potentially countervailing) changes in various risk factors for overdose. To assess whether the net effects of these factors varied geographically, we examined regional variation in the impact of the PHOs on counts of nonfatal overdoses, which have received less attention than fatal overdoses, despite their public health significance.
Data were collected from the Overdose Detection Mapping Application Program (ODMAP), which recorded suspected overdoses between July 1, 2018 and October 25, 2020. We used segmented regression models to assess the impact of PHOs on nonfatal-overdose trends in Washington DC and the five geographical regions of Maryland, using a historical control time series to adjust for normative changes in overdoses that occurred around mid-March (when the PHOs were issued).
The mean level change in nonfatal opioid overdoses immediately after mid-March was not reliably different in the Covid-19 year versus the preceding control time series for any region. However, the rate of increase in nonfatal overdose was steeper after mid-March in the Covid-19 year versus the preceding year for Maryland as a whole (B = 2.36; 95% CI, 0.65 to 4.06; p = .007) and for certain subregions. No differences were observed for Washington DC.
The pandemic and its accompanying PHOs were associated with steeper increases in nonfatal opioid overdoses in most but not all of the regions we assessed, with a net effect that was deleterious for the Maryland region as a whole.
Covid-19 大流行及其伴随的公共卫生令（PHO）导致各种药物过量风险因素发生（潜在的相互矛盾的）变化。为了评估这些因素的净效应是否存在地域差异，我们研究了 PHO 对非致命性药物过量计数的影响的区域差异，尽管它们具有公共卫生意义，但与致命性药物过量相比，它们受到的关注较少。
数据来自于过量检测绘图应用程序（ODMAP），该程序记录了 2018 年 7 月 1 日至 2020 年 10 月 25 日期间的疑似药物过量情况。我们使用分段回归模型，利用历史对照时间序列来调整与 3 月中旬（PHO 发布时）左右发生的药物过量正常变化相关的因素，评估了 PHO 对华盛顿特区和马里兰州五个地理区域非致命性药物过量趋势的影响。
在任何一个地区，3 月中旬之后非致命性阿片类药物过量的平均水平变化在 Covid-19 年与前一年的对照时间序列之间没有可靠差异。然而，与前一年相比，在整个马里兰州（B = 2.36；95%CI，0.65 至 4.06；p =.007）和某些子区域，3 月中旬之后非致命性药物过量的增长率更高。在华盛顿特区没有观察到差异。
大流行及其伴随的 PHO 与我们评估的大多数地区而非所有地区的非致命性阿片类药物过量的增长率增加有关，对马里兰州整体产生了有害的净效应。
