School of Social Work, Faculty of Health and Social Development, The University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts.
Am J Prev Med. 2024 Jan;66(1):10-17. doi: 10.1016/j.amepre.2023.08.016. Epub 2023 Aug 24.
The proliferation of fentanyl and its analogs in illegal, unregulated drug markets remains a major driver of the overdose crisis in North America. Drug checking services have been implemented as a harm reduction strategy to address the crisis. However, little is known about their potential utility as a mechanism for monitoring population-level risk of overdose stemming from changing fentanyl concentration in unregulated drugs over time. Therefore, this study assessed the relationship between median fentanyl concentration in expected opioid drug checking samples and the death rate due to illicit drug toxicity over time in Vancouver, Canada.
Monthly population-based rates of death due to illicit drug toxicity were drawn from provincial coroner records. Monthly median percent fentanyl concentration was calculated using a validated quantification model from point-of-care Fourier-transform infrared spectra among expected opioid samples that tested positive for fentanyl at community drug checking services. A time-series analysis using generalized additive modeling was conducted to examine the association between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, controlling for calendar month. Analyses were conducted in 2021-2022.
Between January 2019 and October 2020, 577 deaths due to illicit drug toxicity occurred in Vancouver, and the observed monthly rate ranged from 1.75 to 7.65 deaths per 100,000 population. A significant, positive association was observed between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, adjusting for calendar month (chi-square=52.21, p<0.001).
Findings suggest a role for point-of-care drug checking as a tool for monitoring evolving overdose risk at the population level.
芬太尼及其类似物在非法、不受监管的毒品市场中的扩散仍然是导致北美阿片类药物过量危机的主要因素。毒品检测服务已作为一种减少伤害的策略实施，以应对这一危机。然而，人们对其作为监测因不受监管药物中芬太尼浓度随时间变化而导致的人群过量风险的机制的潜在效用知之甚少。因此，本研究评估了加拿大温哥华预期阿片类药物检测样本中芬太尼浓度中位数与非法药物毒性导致的死亡率之间的关系。
从省级验尸官记录中提取每月因非法药物毒性导致的人群死亡率。使用社区毒品检测服务中基于傅里叶变换红外光谱的点护理定量模型计算每月预期阿片类药物检测样本中芬太尼的中位数百分比浓度。使用广义加性模型进行时间序列分析，以检验每月中位数芬太尼浓度与每月因非法药物毒性导致的死亡率之间的关联，同时控制日历月份。分析于 2021-2022 年进行。
在 2019 年 1 月至 2020 年 10 月期间，温哥华发生了 577 例因非法药物毒性导致的死亡事件，观察到的每月死亡率范围为每 10 万人 1.75 至 7.65 人。在调整日历月份后，每月中位数芬太尼浓度与每月因非法药物毒性导致的死亡率之间存在显著正相关（卡方=52.21，p<0.001）。
研究结果表明，即时药物检测作为监测人群中不断变化的过量风险的工具具有一定作用。
