Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA.
Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine & Bayhealth Medical Center, Dover, DE, USA.
Clin Toxicol (Phila). 2023 May;61(5):400-407. doi: 10.1080/15563650.2023.2185494. Epub 2023 Apr 21.
Cocaine and metamfetamine use and overdose deaths among United States adults have been increasing in recent years. We examined associations of medical outcomes with co-used opioids and other substances among cocaine, and metamfetamine exposures in people age ≥50 years ( = 9300) reported to the National Poison Data System, 2015-2021.
We first described increases in these exposures over time. We fitted generalized linear models for a Poisson distribution with a log link, one for cocaine exposures and the other for metamfetamine exposures, to examine associations of medical outcomes (major effects/death versus all others) with co-used other substances, controlling for exposure year and demographics.
The number of exposures increased steadily during the seven years, but metamfetamine exposures increased more rapidly starting in 2018. One-fifth of cocaine and one-sixth of metamfetamine exposures suffered major effects/death. Co-use of prescription opioids (incident risk ratio = 2.00, 95% CI = 1.76-2.28 for cocaine; incident risk ratio = 1.62, 95% CI = 1.27-2.07 for metamfetamine), illicit fentanyl (incident risk ratio =1.88, 95% CI = 1.08-3.27 for cocaine; incident risk ratio = 2.05, 95% CI = 1.04-4.06 for metamfetamine), heroin (incident risk ratio =1.62, 95% CI = 1.37-1.90 for cocaine), or amfetamine (incident risk ratio =1.73, 95% CI = 1.28-2.33 for cocaine) was associated with a higher likelihood of major effects/death.
Increases in the number of cocaine and metamfetamine exposures among older adults reported to poison centers are of concern, and so is the increased risk of major effects/death from polysubstance use, especially prescription and illicit opioids, among these illicit psychostimulant users.
Healthcare provider screening of individuals at risk of cocaine and/or metamfetamine use and psychoeducation about the dangers of these substance use are needed.
近年来，美国成年人可卡因和甲基苯丙胺的使用和过量死亡人数一直在增加。我们研究了在年龄≥50 岁（ = 9300）的人群中，与可卡因和甲基苯丙胺暴露相关的医疗结果与共同使用的阿片类药物和其他物质之间的关联，这些人群向国家毒物数据系统报告，时间为 2015-2021 年。
我们首先描述了这些暴露在时间上的增加。我们为泊松分布拟合了广义线性模型，一个用于可卡因暴露，另一个用于甲基苯丙胺暴露，以检查共同使用的其他物质与医疗结果（主要影响/死亡与其他所有结果）之间的关联，控制暴露年份和人口统计学因素。
七年来，暴露人数稳步增加，但从 2018 年开始，甲基苯丙胺的暴露人数增加得更快。五分之一的可卡因和六分之一的甲基苯丙胺暴露者遭受了主要影响/死亡。同时使用处方类阿片（发病风险比 = 2.00，95%置信区间= 1.76-2.28 用于可卡因；发病风险比 = 1.62，95%置信区间= 1.27-2.07 用于甲基苯丙胺）、非法芬太尼（发病风险比 = 1.88，95%置信区间= 1.08-3.27 用于可卡因；发病风险比 = 2.05，95%置信区间= 1.04-4.06 用于甲基苯丙胺）、海洛因（发病风险比 = 1.62，95%置信区间= 1.37-1.90 用于可卡因）或苯丙胺（发病风险比 = 1.73，95%置信区间= 1.28-2.33 用于可卡因）与主要影响/死亡的可能性增加有关。
向中毒控制中心报告的老年人群中可卡因和/或甲基苯丙胺暴露人数的增加令人担忧，特别是在这些非法兴奋剂使用者中，同时使用多种物质（尤其是处方和非法阿片类药物）导致主要影响/死亡的风险增加。
需要对有可卡因和/或甲基苯丙胺使用风险的个体进行医疗提供者筛查，并对这些物质使用的危险进行心理教育。
