Liu Xiguang, Singer Mendel E
Case Western Reserve University, Dept. of Population and Quantitative Health Sciences, 10900 Euclid Ave, SOM WG-57, Cleveland, OH 44106, United States.
Prev Med Rep. 2023 May 5;33:102227. doi: 10.1016/j.pmedr.2023.102227. eCollection 2023 Jun.
The combination of opioids and cocaine has been increasingly implicated in overdose fatalities, but it is unknown how much is intentional vs. fentanyl-adulterated drug supply. 2017-2019 data from the nationally representative National Survey on Drug Use and Health (NSDUH) was used. Variables included sociodemographics, health, and 30-day drug use. Opioid use captured heroin, and prescription pain reliever use not according to own doctor. Modified Poisson regressions were used to estimate prevalence ratios (PRs) for variables associated with opioid and cocaine use. Among the 167,444 responders, 817(0.49%) reported use of opioids on a regular or daily basis. Of these, 28% used cocaine ≥1 of prior 30 days, 11% >1 day. Of 332(0.20%) who used cocaine on a regular/daily basis, 48% used opioids ≥1 of prior 30 days, 25% >1 day. People with serious psychological distress were >6 times as likely to use both opioids and cocaine regularly/daily (PR = 6.48; 95% CI = [2.82-14.90]) and people who have never been married were 4 times as likely (PR = 4.17; 95% CI = [1.18-14.75]). Compared to those living in a small metropolitan region, people living in a large metropolitan region were >3 times as likely (PR = 3.29; 95% CI = [1.43-7.58]) and the unemployed were twice as likely (PR = 1.96; 95% CI = [1.03-3.73]). People with post-high school education were 53% less likely to use opioids and cocaine at least occasionally (PR = 0.47; 95% CI = [0.26-0.86]). People who use opioids or cocaine commonly choose to use the other. Knowing the characteristics of those most likely to use both should guide interventions for prevention and harm reduction.
阿片类药物和可卡因的联用与过量致死的关联日益增加，但尚不清楚有多少是因故意使用，又有多少是因掺有芬太尼的毒品供应。本研究使用了具有全国代表性的2017 - 2019年全国药物使用和健康调查（NSDUH）的数据。变量包括社会人口统计学、健康状况以及30天内的药物使用情况。阿片类药物使用情况涵盖海洛因以及未按医嘱使用的处方止痛药。采用修正泊松回归来估计与阿片类药物和可卡因使用相关变量的患病率比（PRs）。在167,444名受访者中，817人（0.49%）报告经常或每日使用阿片类药物。其中，28%的人在过去30天内至少有1天使用过可卡因，11%的人使用天数超过1天。在332名（0.20%）经常/每日使用可卡因的人中，48%的人在过去30天内至少有1天使用过阿片类药物，25%的人使用天数超过1天。有严重心理困扰的人经常/每日同时使用阿片类药物和可卡因的可能性是其他人的6倍多（PR = 6.48；95%置信区间 = [2.82 - 14.90]），从未结婚的人可能性是4倍（PR = 4.17；95%置信区间 = [1.18 - 14.75]）。与生活在小都市地区的人相比，生活在大都市地区的人可能性是3倍多（PR = 3.29；95%置信区间 = [1.43 - 7.58]），失业者可能性是2倍（PR = 1.96；95%置信区间 = [1.03 - 3.73]）。高中以上学历的人至少偶尔同时使用阿片类药物和可卡因的可能性低53%（PR = 0.47；95%置信区间 = [0.26 - 0.86]）。使用阿片类药物或可卡因的人通常也会选择使用另一种。了解最有可能同时使用这两种药物的人的特征，应有助于指导预防和减少伤害的干预措施。
