National Network of Public Health Institutes, New Orleans, LA, USA.
Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Med Toxicol. 2023 Apr;19(2):180-189. doi: 10.1007/s13181-022-00924-0. Epub 2023 Jan 17.
To characterize and compare opioid-only, cocaine-only, methamphetamine-only, opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure and to examine clinical presentations, leading to a better understanding of overdose effects involving these drug exposures.
We examined drug exposures in the Toxicology Investigators Consortium (ToxIC) Core Registry from January 2010 to December 2021, a case registry of patients presenting to participating healthcare sites that receive a medical toxicology consultation. Demographic and clinical presentations of opioid-only, cocaine-only, methamphetamine-only, and opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure consultations were described; differences between single and polydrug exposure subgroups were calculated to determine statistical significance. Clinical presentations associated with exposures were evaluated through calculated adjusted relative risk.
A total of 3,883 consultations involved opioids, cocaine, methamphetamine, opioid-and-cocaine exposure, or opioid-and-methamphetamine exposure. Opioid-only (n = 2,268, 58.4%) and methamphetamine-only (n = 712, 18.3%) comprised most consultations. There were significant differences in clinical presentations between exposure subgroups. Opioid-and-cocaine exposure consultations were 8.15 times as likely to present with a sympathomimetic toxidrome than opioid-only. Conversely, opioid-and-cocaine exposure and opioid-and-methamphetamine exposure were 0.32 and 0.42 times as likely to present with a sympathomimetic toxidrome compared to cocaine-only and methamphetamine-only consultations, respectively. Opioid-and-cocaine exposure was 0.67 and opioid-and-methamphetamine exposure was 0.74 times as likely to present with respiratory depression compared to opioid-only consultations. Similarly, opioid-and-cocaine exposure was 0.71 and opioid-and-methamphetamine exposure was 0.78 times as likely to present with CNS depression compared to opioid-only consultations.
Used in combination, opioids and stimulants may mask typical clinical presentations of one another, misattributing incorrect drugs to overdose in both clinical treatment and public health surveillance.
为了描述和比较阿片类药物暴露、可卡因暴露、甲基苯丙胺暴露、阿片类药物和可卡因混合暴露以及阿片类药物和甲基苯丙胺混合暴露，并研究导致更好地理解这些药物暴露引起的过量效应的临床表现。
我们检查了 2010 年 1 月至 2021 年 12 月毒理学调查人员联合会（ToxIC）核心登记处的药物暴露情况，这是一个患者登记处，他们在参与的医疗机构就诊，这些医疗机构接受医疗毒理学咨询。描述了阿片类药物暴露、可卡因暴露、甲基苯丙胺暴露、阿片类药物和可卡因混合暴露以及阿片类药物和甲基苯丙胺混合暴露咨询的人口统计学和临床表现；计算单药和多药暴露亚组之间的差异，以确定统计学意义。通过计算调整后的相对风险评估与暴露相关的临床表现。
共有 3883 次咨询涉及阿片类药物、可卡因、甲基苯丙胺、阿片类药物和可卡因混合暴露或阿片类药物和甲基苯丙胺混合暴露。阿片类药物暴露（n=2268，58.4%）和甲基苯丙胺暴露（n=712，18.3%）占大多数咨询。暴露亚组之间的临床表现存在显著差异。与阿片类药物暴露相比，阿片类药物和可卡因混合暴露出现拟交感神经中毒症状的可能性高 8.15 倍。相反，与可卡因和甲基苯丙胺单独暴露相比，阿片类药物和可卡因混合暴露和阿片类药物和甲基苯丙胺混合暴露出现拟交感神经中毒症状的可能性分别低 0.32 倍和 0.42 倍。与阿片类药物暴露相比，阿片类药物和可卡因混合暴露出现呼吸抑制的可能性高 0.67 倍，阿片类药物和甲基苯丙胺混合暴露出现呼吸抑制的可能性高 0.74 倍。同样，与阿片类药物暴露相比，阿片类药物和可卡因混合暴露出现中枢神经系统抑制的可能性高 0.71 倍，阿片类药物和甲基苯丙胺混合暴露出现中枢神经系统抑制的可能性高 0.78 倍。
阿片类药物和兴奋剂联合使用时，可能会掩盖彼此的典型临床表现，在临床治疗和公共卫生监测中错误地将不正确的药物归因于过量。
