DC Department of Health, 899 North Capitol St NE, Washington, DC 20002, USA.
CDC Foundation, 600 Peachtree St NE #1000, Atlanta, GA 30308, USA.
J Anal Toxicol. 2023 Sep 15;47(7):588-596. doi: 10.1093/jat/bkad052.
This cross-sectional analysis aimed to understand the similarities and differences between drugs detected in syringes collected from syringe service providers in the District of Columbia and fatal overdose deaths captured by the State Unintentional Drug Overdose Reporting System. Substance exposures for these fatal and non-fatal drug use outcomes have not been previously compared. Substance distributions were examined and a paired significance test was used to compare changes over time. Affinity analysis was employed to reveal substance co-occurrences. Between September 2020 and September 2022, 1,118 postmortem blood samples (PBSs) and 3,646 syringes exchange samples (SESs) were processed, with fatal overdoses increasing 24.1%. Polysubstance use was more commonly found in postmortem blood (82.5%) than in syringe samples (48.6%). Of samples containing opioids, 94.8% of blood samples and 86.3% of syringes contained fentanyl, fentanyl analogs or fentanyl precursors/metabolites. PBSs had double the frequency of co-occurring stimulants and opioids (43.9%) as SESs (21.8%). Major changes in occurrence frequency over time were found for opioid and stimulant exposure in both groups, especially in the increased occurrence of fluorofentanyl (>400%), methamphetamine (>90%) and xylazine (>60%), while the incidence of fentanyl, heroin and metabolite morphine declined. These results indicate that while fatal use and syringe exchange populations have distinct substance exposures, which may contribute to differences in mortality rate, their substance distributions have similar change magnitudes. This study highlights the utility of using multiple data sources to provide a comprehensive description of drug use patterns and discusses the limitations in reporting data from each source.
本横断面分析旨在了解哥伦比亚特区注射器服务提供者收集的注射器中检测到的药物与州意外药物过量报告系统中捕获的致命过量死亡之间的相似之处和差异。这些致命和非致命药物使用结果的物质暴露以前没有被比较过。检查了物质分布，并使用配对显著性检验比较了随时间的变化。亲和力分析用于揭示物质共现。在 2020 年 9 月至 2022 年 9 月期间，处理了 1118 份死后血液样本（PBS）和 3646 份注射器交换样本（SES），致命过量增加了 24.1%。多物质使用在死后血液（82.5%）中比在注射器样本（48.6%）中更常见。在含有阿片类药物的样本中，94.8%的血液样本和 86.3%的注射器含有芬太尼、芬太尼类似物或芬太尼前体/代谢物。PBS 中同时存在兴奋剂和阿片类药物的频率是 SES 的两倍（43.9%对 21.8%）。两组中阿片类药物和兴奋剂暴露的发生频率都发生了重大变化，尤其是氟芬太尼（>400%）、甲基苯丙胺（>90%）和唑吡坦（>60%）的发生率增加，而芬太尼、海洛因和代谢物吗啡的发生率下降。这些结果表明，尽管致命使用和注射器交换人群的物质暴露存在明显差异，这可能导致死亡率的差异，但它们的物质分布具有相似的变化幅度。本研究强调了使用多种数据源提供药物使用模式全面描述的效用，并讨论了从每个来源报告数据的局限性。
