Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Int J Drug Policy. 2023 Aug;118:104118. doi: 10.1016/j.drugpo.2023.104118. Epub 2023 Jul 7.
The North American overdose crisis has continued at unprecedented rates with more than 100,000 overdose deaths estimated to have occurred in the United States in 2022. Regional variations in overdose rates signify differences in local drug supplies. State-level drug supply surveillance systems have been limited in their ability to document and communicate the rapidly changing drug supplies which can hinder harm reduction efforts at the community level. We sought to address by piloting a two-year, community-engaged local drug supply surveillance program in Rhode Island (RI).
The first set of samples (n = 125) were collected from May 2022 to January 2023 across RI and included used paraphernalia (e.g., cookers), refuse (e.g., baggies), and product. Samples were tested using comprehensive toxicology testing approaches via liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS). Results were disseminated to participants and the broader public across platforms.
Fentanyl was detected in 67.2% of all samples tested. 39.2% (n = 49) of samples were expected to be fentanyl. Xylazine was detected in 41.6% of all samples-always in combination with fentanyl-and no samples were expected to contain xylazine. In expected stimulant samples (n = 39), 10% contained fentanyl and/or analogues as major substances and 30.8% contained trace amounts of fentanyl and/or analogues. In expected stimulant samples, 15.4% contained xylazine with fentanyl. No opioids or benzodiazepines were detected in expected hallucinogen or dissociative samples (n = 7). In expected benzodiazepine samples (n = 8), no opioids were detected.
Our results describe part of the local drug supply in Rhode Island, including a presence of NPS and adulterants (e.g., designer benzodiazepines, xylazine). Importantly, our findings underscore the feasibility of developing a community-driven drug supply surveillance database. Expanding drug supply surveillance initiatives is imperative for improving the health and safety of people who use drugs and informing public health approaches to addressing the overdose crisis.
北美阿片类药物过量危机仍在以空前的速度持续，据估计，2022 年美国有超过 10 万人死于药物过量。过量率的地区差异表明当地毒品供应存在差异。州级药物供应监测系统在记录和传播快速变化的毒品供应方面能力有限，这可能会阻碍社区层面的减少伤害工作。我们试图通过在罗得岛州（RI）试点一个为期两年的社区参与式当地毒品供应监测项目来解决这个问题。
第一组样本（n=125）于 2022 年 5 月至 2023 年 1 月在罗得岛州各地采集，包括使用的用具（如炊具）、垃圾（如塑料袋）和产品。样品采用液相色谱-四极杆飞行时间质谱（LC-QTOF-MS）的综合毒理学检测方法进行检测。结果通过各种平台分发给参与者和更广泛的公众。
在所检测的所有样本中，芬太尼的检出率为 67.2%。39.2%（n=49）的样本预计含有芬太尼。在所有样本中，苯环己哌啶的检出率为 41.6%——总是与芬太尼一起存在——没有样本预计含有苯环己哌啶。在预计的兴奋剂样本（n=39）中，10%的主要物质含有芬太尼和/或类似物，30.8%的样本含有痕量的芬太尼和/或类似物。在预计的兴奋剂样本中，15.4%的样本含有芬太尼和苯环己哌啶。在预计的致幻剂或分离剂样本（n=7）中未检测到阿片类药物或苯二氮䓬类药物。在预计的苯二氮䓬类药物样本（n=8）中，未检测到阿片类药物。
我们的结果描述了罗得岛州部分当地毒品供应情况，包括新精神活性物质和掺杂物（如设计苯二氮䓬类药物、苯环己哌啶）的存在。重要的是，我们的发现强调了开发社区驱动的毒品供应监测数据库的可行性。扩大毒品供应监测计划对于改善吸毒者的健康和安全以及为解决阿片类药物过量危机提供公共卫生方法至关重要。
