SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, the United States of America; Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America.
Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; VA Connecticut Healthcare System, West Haven, CT, the United States of America.
Drug Alcohol Depend. 2023 Mar 1;244:109788. doi: 10.1016/j.drugalcdep.2023.109788. Epub 2023 Jan 30.
Opioid overdoses are a leading cause of preventable death in the United States. There is limited research linking decedents' receipt of controlled substances and presence of controlled substances on post-mortem toxicology (PMT).
We linked data on opioid-detected deaths in Connecticut between May 3, 2016, and December 31, 2017 from the Office of the Chief Medical Examiner, Department of Consumer Protection, and Department of Mental Health and Addiction Services. Exposure was defined as receipt of an opioid or benzodiazepine prescription within 90 days prior to death. Our primary outcome was concordance between medication received and metabolites in PMT.
Our analysis included 1412 opioid-detected overdose deaths. 47 % received an opioid or benzodiazepine 90 days prior to death; 36 % received an opioid and 27 % received a benzodiazepine. Concordance between receipt of an opioid or benzodiazepine and its presence in PMT was observed in 30 % of opioid-detected deaths. Concordance with an opioid was present in 17 % of opioid-detected deaths and concordance with a benzodiazepine was present in 21 % of opioid-detected deaths. Receipt of an opioid or benzodiazepine and concordance with PMT were less common in fentanyl or heroin-detected deaths and more common in pharmaceutical opioid-detected deaths.
Our results suggest medically supplied opioids and benzodiazepines potentially contributed to a substantial number, though minority, of opioid-detected deaths during the study period. Efforts to reduce opioid and benzodiazepine prescribing may reduce risk of opioid-detected deaths in this group, but other approaches will be needed to address most opioid-detected deaths that involved non-pharmaceutical opioids.
在美国，阿片类药物过量是可预防死亡的主要原因。将死者接受管制物质和死后毒理学（PMT）中存在管制物质联系起来的研究有限。
我们将康涅狄格州法医办公室、消费者保护部和心理健康和成瘾服务部 2016 年 5 月 3 日至 2017 年 12 月 31 日期间阿片类药物检测死亡的数据进行了关联。暴露定义为在死亡前 90 天内收到阿片类药物或苯二氮䓬类药物的处方。我们的主要结果是收到的药物与 PMT 中的代谢物之间的一致性。
我们的分析包括 1412 例阿片类药物检测过量死亡。47%的人在死亡前 90 天内收到阿片类药物或苯二氮䓬类药物；36%的人收到阿片类药物，27%的人收到苯二氮䓬类药物。在阿片类药物检测死亡中，30%的人观察到收到阿片类药物或苯二氮䓬类药物与 PMT 中的药物存在一致性。在阿片类药物检测死亡中，17%的人存在阿片类药物一致性，21%的人存在苯二氮䓬类药物一致性。在芬太尼或海洛因检测死亡中，收到阿片类药物或苯二氮䓬类药物与 PMT 一致的情况较少，而在药物类阿片检测死亡中则较为常见。
我们的结果表明，在研究期间，医疗供应的阿片类药物和苯二氮䓬类药物可能导致相当数量（尽管是少数）阿片类药物检测死亡。减少阿片类药物和苯二氮䓬类药物的处方可能会降低该人群阿片类药物检测死亡的风险，但需要采取其他方法来解决涉及非药物类阿片类药物的大多数阿片类药物检测死亡。
