农村地区冰毒和阿片类药物使用与非致命性药物过量的关联。

Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities.

机构信息

Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland.

Oregon Health & Science University-Portland State University School of Public Health, Portland.

出版信息

JAMA Netw Open. 2022 Aug 1;5(8):e2226544. doi: 10.1001/jamanetworkopen.2022.26544.

DOI:10.1001/jamanetworkopen.2022.26544

PMID:35969400

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9379740/

Abstract

IMPORTANCE

Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities.

OBJECTIVE

To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether methamphetamine use is associated with increased nonfatal overdoses.

DESIGN, SETTING, AND PARTICIPANTS: From January 2018 through March 2020, the National Rural Opioid Initiative conducted cross-sectional surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin). Participants included rural PWUD who reported any past-30-day injection drug use or noninjection opioid use to get high. A modified chain-referral sampling strategy identified seeds who referred others using drugs. Data analysis was performed from May 2021 to January 2022.

EXPOSURES

Use of methamphetamine alone, opioids alone, or both.

MAIN OUTCOMES AND MEASURES

Unweighted and weighted prevalence of methamphetamine use, any past-180-day nonfatal overdose, and number of lifetime nonfatal overdoses.

RESULTS

Among the 3048 participants, 1737 (57%) were male, 2576 (85%) were White, and 225 (7.4%) were American Indian; the mean (SD) age was 36 (10) years. Most participants (1878 of 2970 participants with any opioid or methamphetamine use [63%]) reported co-use of methamphetamine and opioids, followed by opioids alone (702 participants [24%]), and methamphetamine alone (390 participants [13%]). The estimated unweighted prevalence of methamphetamine use was 80% (95% CI, 64%-90%), and the estimated weighted prevalence was 79% (95% CI, 57%-91%). Nonfatal overdose was greatest in people using both methamphetamine and opioids (395 of 2854 participants with nonmissing overdose data [22%]) vs opioids alone (99 participants [14%]) or methamphetamine alone (23 participants [6%]). Co-use of methamphetamine and opioids was associated with greater nonfatal overdose compared with opioid use alone (adjusted odds ratio, 1.45; 95% CI, 1.08-1.94; P = .01) and methamphetamine use alone (adjusted odds ratio, 3.26; 95% CI, 2.06-5.14; P < .001). Those with co-use had a mean (SD) of 2.4 (4.2) (median [IQR], 1 [0-3]) lifetime overdoses compared with 1.7 (3.5) (median [IQR], 0 [0-2]) among those using opioids alone (adjusted rate ratio, 1.20; 95% CI, 1.01-1.43; P = .04), and 1.1 (2.9) (median [IQR], 0 [0-1]) among those using methamphetamine alone (adjusted rate ratio, 1.81; 95% CI, 1.45-2.27; P < .001). Participants with co-use most often reported having tried and failed to access substance use treatment: 827 participants (44%) for both, 117 participants (30%) for methamphetamine alone, and 252 participants (36%) for opioids alone (χ22 = 33.8; P < .001). Only 66 participants (17%) using methamphetamine alone had naloxone.

CONCLUSIONS AND RELEVANCE

These findings suggest that harm reduction and substance use disorder treatment interventions must address both methamphetamine and opioids to decrease overdose in rural communities.

摘要

重要性

在美国，过量用药的情况仍在持续增加，但农村社区中使用冰毒的情况在医学研究中仍研究不足。

目的

评估美国农村社区中药物使用者（PWUD）中冰毒使用的流行率及其相关因素，并确定冰毒使用是否与非致命性过量用药的增加有关。

设计、地点和参与者：从 2018 年 1 月到 2020 年 3 月，国家农村阿片倡议在 10 个州（伊利诺伊州、肯塔基州、新罕布什尔州、马萨诸塞州、北卡罗来纳州、俄亥俄州、俄勒冈州、佛蒙特州、西弗吉尼亚州和威斯康星州）的农村社区中对药物使用者进行了横断面调查。参与者包括报告过去 30 天内有注射药物使用或非注射类阿片类药物使用以获得快感的农村药物使用者。一种改良的连锁式抽样策略确定了可以推荐其他药物使用者的种子。数据分析于 2021 年 5 月至 2022 年 1 月进行。

暴露

单独使用冰毒、单独使用阿片类药物，或两者兼用。

主要结果和措施

未加权和加权的冰毒使用流行率、过去 180 天内任何非致命性过量用药的发生次数以及终生非致命性过量用药的发生次数。

结果

在 3048 名参与者中，1737 名（57%）为男性，2576 名（85%）为白人，225 名（7.4%）为美国印第安人；平均（SD）年龄为 36（10）岁。大多数参与者（2970 名有任何阿片类药物或冰毒使用的参与者中的 1878 名[63%]）报告同时使用冰毒和阿片类药物，其次是单独使用阿片类药物（702 名[24%]）和单独使用冰毒（390 名[13%]）。未加权的冰毒使用流行率估计为 80%（95%CI，64%-90%），加权的流行率估计为 79%（95%CI，57%-91%）。在同时使用冰毒和阿片类药物的人群中（2854 名有非缺失过量用药数据的参与者中 395 名[22%]）与单独使用阿片类药物（99 名[14%]）或单独使用冰毒（23 名[6%]）相比，非致命性过量用药的发生率最高。与单独使用阿片类药物相比，同时使用冰毒和阿片类药物与非致命性过量用药有关（调整后的优势比，1.45；95%CI，1.08-1.94；P=0.01），与单独使用冰毒有关（调整后的优势比，3.26；95%CI，2.06-5.14；P<0.001）。同时使用的参与者一生中平均（SD）有 2.4（4.2）（中位数[IQR]，1 [0-3]）次过量用药，而单独使用阿片类药物的参与者有 1.7（3.5）（中位数[IQR]，0 [0-2]）（调整后的率比，1.20；95%CI，1.01-1.43；P=0.04），单独使用冰毒的参与者有 1.1（2.9）（中位数[IQR]，0 [0-1]）（调整后的率比，1.81；95%CI，1.45-2.27；P<0.001）。同时使用的参与者中，大多数人报告尝试并未能获得药物使用治疗：827 名（44%）同时使用冰毒和阿片类药物，117 名（30%）单独使用冰毒，252 名（36%）单独使用阿片类药物（χ22=33.8；P<0.001）。只有 66 名（17%）单独使用冰毒的参与者接受过纳洛酮治疗。