Addiction Research Group, IMIM- Hospital del Mar Medical Research Institute, Barcelona, Spain.
Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain.
Eur Addict Res. 2022;28(5):323-330. doi: 10.1159/000524011. Epub 2022 Apr 4.
New synthetic opioids (NSO), a class of new psychoactive substances (NPS), have recently emerged and pose an upcoming global public health challenge. The effects produced by NSO are similar to those from morphine, but they present greater pharmacological potency and abuse potential. Due to the increasing number of fatal overdoses and seizures in which NSO have been detected as heroin substitutes or adulterants, individuals with Opioid Use Disorder (OUD) represent a vulnerable population. The aim of our study was to describe and characterize from a gender perspective a Spanish cohort of potential conscious or unconscious NSO users.
A cross-sectional study was conducted in a cohort of OUD participants under treatment in addiction care services in Barcelona and Badalona, Spain. Clinical evaluation was performed through an ad hoc survey, a scale to evaluate reasons to use an opioid without prescription (range 0-4) and the Wellbeing Index (WHO-5) (range 0-100). Objective consumption of NSO was assessed by urinalysis carried out by two validated methods: high-sensitivity gas chromatography-mass spectrometry (MS) and ultra-high-performance liquid chromatography-high-resolution MS.
A total of 154 participants with OUD were enrolled. They were mainly men (72.7%), mean age 47.8 years. Methadone was the predominant medication for opioid agonist treatment (mean dose 61.25 mg/day). A total of 32 (20.8%) participants reported having consumed some opioid to become "high" in the previous 3 months. The principal reasons for consuming illicit opioids were Replacing other drugs (mean 2.03) and Availability (mean 1.62), although Low price, was more highly valued by men (p = 0.045) and Shorter effect duration, most highly rated by women (p = <0.001). In the WHO-5, the mean score was 55 (SD = 30.1) without differences by gender. Fentanyl and derivatives or/and metabolites were detected in 7 (6.1%) participants, but illicit/non-prescribed NSOs were found in 5 out of 114 patients (4.4%), and other non-fentanyl opioids in 36 participants (26 men and 10 women).
A non-negligible consumption of NSO-fentanyl's (positive detection in 6.1% of biological samples) was detected. The reasons for using these substances and also the well-being differed between the genders. There is therefore both voluntary and involuntary NSO consumption in our country which highlights the importance of approaching this potential public health problem.
新合成阿片类物质（NSO）是一类新的精神活性物质（NPS），最近出现，对全球公共健康构成了潜在威胁。NSO 产生的作用类似于吗啡，但它们具有更大的药理学效力和滥用潜力。由于越来越多的致命过量和癫痫发作中检测到 NSO 作为海洛因替代品或掺杂物，阿片类药物使用障碍（OUD）患者代表了一个脆弱的人群。我们的研究目的是从性别角度描述和描绘西班牙一组潜在的有意识或无意识 NSO 使用者。
在巴塞罗那和巴达洛纳的西班牙成瘾护理服务中，对一组接受 OUD 治疗的参与者进行了横断面研究。通过专门的调查、评估未经处方使用阿片类药物原因的量表（范围 0-4）和幸福感指数（WHO-5）（范围 0-100）进行临床评估。通过两种经过验证的方法进行尿液分析来评估 NSO 的客观消费：高灵敏度气相色谱-质谱联用仪（MS）和超高效液相色谱-高分辨率 MS。
共纳入 154 名 OUD 参与者。他们主要是男性（72.7%），平均年龄 47.8 岁。美沙酮是阿片类激动剂治疗的主要药物（平均剂量为 61.25mg/天）。共有 32 名（20.8%）参与者报告在过去 3 个月内曾使用过一些阿片类药物来“兴奋”。消费非法阿片类药物的主要原因是替代其他药物（平均 2.03）和可用性（平均 1.62），尽管价格低，更受男性重视（p=0.045），而作用持续时间短，更受女性重视（p<0.001）。在 WHO-5 中，平均得分为 55（SD=30.1），性别之间无差异。在 7 名（6.1%）参与者中检测到芬太尼及其衍生物或/和代谢物，但在 114 名患者中有 5 名（4.4%）发现非法/未处方 NSO，36 名（26 名男性和 10 名女性）发现其他非芬太尼类阿片类药物。
在我们的国家，检测到了不可忽视的 NSO-芬太尼的消费（生物样本阳性检出率为 6.1%）。使用这些物质的原因以及幸福感在性别之间存在差异。因此，我们国家既有自愿的也有无意识的 NSO 消费，这凸显了解决这一潜在公共卫生问题的重要性。
