West Virginia University Health Affairs Institute, Morgantown, West Virginia.
West Virginia University School of Pharmacy, Morgantown, West Virginia.
J Stud Alcohol Drugs. 2023 Jan;84(1):171-179. doi: 10.15288/jsad.22-00049.
Medications used to treat opioid use disorder (OUD) reduce drug overdose risk. Buprenorphine is often the preferred treatment for OUD because of its high safety profile. Given expanding buprenorphine use, this study sought to examine buprenorphine-involved deaths (BIDs) and compare them with other drug-related deaths.
West Virginia drug-related deaths from 2005 to early 2020 were identified. Study data included decedent demographics, toxicology, autopsy findings, and medical and prescription histories. Characteristics of BIDs compared with other drug-related deaths were statistically analyzed.
Among 11,764 drug-related deaths, only 564 (4.8%) involved buprenorphine. Buprenorphine alone was present in 32 deaths, of which 20 were considered the direct cause of death (0.2% of all drug-related deaths). Significantly more BIDs involved five or more drugs (23%) compared with other opioid deaths (14.9%). Co-intoxicants found most frequently in BIDs were benzodiazepines (47.3%), methamphetamine (27.1%), and fentanyl (22.9%). Cardiovascular and pulmonary comorbidities were identified in 43% and 21% of BIDs, respectively. Of the 564 BIDs, a current buprenorphine prescription was present in 132 deaths (23.4%).
Despite increasing buprenorphine use, BIDs comprised less than 5% of overall West Virginia drug-related deaths. Seldom was it the only drug found, and most decedents did not have current prescriptions for buprenorphine. Although buprenorphine is effective, with a wide safety margin, clinicians and patients should be aware that buprenorphine can be involved in overdose deaths, especially when buprenorphine is taken in combination with drugs such as benzodiazepines, methamphetamine, or fentanyl, and in persons with underlying cardiovascular or pulmonary comorbidities.
治疗阿片类药物使用障碍（OUD）的药物可降低药物过量风险。丁丙诺啡由于其高安全性通常是 OUD 的首选治疗药物。鉴于丁丙诺啡的使用不断扩大，本研究旨在研究丁丙诺啡相关死亡（BIDs）并将其与其他与药物相关的死亡进行比较。
确定了 2005 年至 2020 年初西弗吉尼亚州与药物相关的死亡病例。研究数据包括死者人口统计学特征、毒理学、尸检结果以及医疗和处方史。对 BIDs 与其他与药物相关的死亡的特征进行了统计学分析。
在 11764 例与药物相关的死亡中，仅有 564 例（4.8%）涉及丁丙诺啡。仅丁丙诺啡存在于 32 例死亡中，其中 20 例被认为是直接死因（占所有与药物相关的死亡的 0.2%）。与其他阿片类药物死亡相比，BIDs 中涉及五种或更多药物的比例显著更高（23%）。在 BIDs 中最常发现的共毒物是苯二氮䓬类（47.3%）、甲基苯丙胺（27.1%）和芬太尼（22.9%）。在 BIDs 中分别发现了 43%和 21%的心血管和肺部合并症。在 564 例 BIDs 中，有 132 例（23.4%）目前正在服用丁丙诺啡处方。
尽管丁丙诺啡的使用不断增加，但 BIDs 占西弗吉尼亚州与药物相关的死亡总数的比例不足 5%。很少发现它是唯一的药物，大多数死者没有丁丙诺啡的当前处方。尽管丁丙诺啡有效且安全性高，但临床医生和患者应注意，丁丙诺啡可能涉及药物过量死亡，尤其是当丁丙诺啡与苯二氮䓬类、甲基苯丙胺或芬太尼等药物联合使用时，以及在有潜在心血管或肺部合并症的人群中。
