Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA.
Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA.
Subst Abuse Treat Prev Policy. 2023 Sep 1;18(1):53. doi: 10.1186/s13011-023-00561-y.
The shift from prescription to illicit drugs involved in drug poisoning deaths raises questions about the current utility of prescription drug monitoring program (PDMP) data to inform drug poisoning (overdose) prevention efforts. In this study, we describe relations between specific drugs involved in Kentucky drug poisoning deaths and antecedent controlled substance (CS) dispensing.
The study used linked death certificates and PDMP data for 2,248 Kentucky resident drug poisoning deaths in 2021. Death certificate literal text analysis identified drugs mentioned with involvement (DMI) in drug poisoning deaths. We characterized the concordance between each DMI and the CS dispensing history for this drug at varying timepoints since 2008.
Overall, 25.5% of all decedents had dispensed CS in the month before fatal drug poisoning. Over 80% of decedents were dispensed opioid(s) since 2008; the percentage was similar regardless of opioid involvement in the poisoning death. One-third of decedents had dispensed buprenorphine for treatment of opioid use disorder since 2008, but only 6.1% had dispensed buprenorphine in the month preceding death. Fentanyl/fentanyl analogs were DMI in 1,568 (69.8%) deaths, yet only 3% had received a fentanyl prescription since 2008. The highest concordance in the month preceding death was observed for clonazepam (43.6%).
Overall, concordance between CS dispensing history and the drugs involved in poisoning deaths was low, suggesting a need to reevaluate the complex relationships between prescription medication exposure and overdose death and to expand harm reduction interventions both within and outside the healthcare system to reduce drug poisoning mortality.
从处方药物到涉及药物中毒死亡的非法药物的转变引发了关于当前使用处方药物监测计划（PDMP）数据来为药物中毒（过量）预防工作提供信息的有效性问题。在这项研究中，我们描述了肯塔基州药物中毒死亡中涉及的特定药物与先前受控物质（CS）配药之间的关系。
该研究使用了 2021 年 2248 名肯塔基州居民药物中毒死亡的死亡证明和 PDMP 数据。死亡证明文字分析确定了与药物中毒死亡有关的涉及药物（DMI）。我们描述了在 2008 年以来的不同时间点，每种 DMI 与该药物的 CS 配药历史之间的一致性。
总体而言，所有死者中有 25.5%在致命药物中毒前一个月有 CS 配药。超过 80%的死者自 2008 年以来有阿片类药物的配药记录；无论中毒死亡是否涉及阿片类药物，这一比例相似。三分之一的死者自 2008 年以来因治疗阿片类药物使用障碍而接受过丁丙诺啡配药，但只有 6.1%在死亡前一个月接受过丁丙诺啡配药。芬太尼/芬太尼类似物是 1568 例（69.8%）死亡中的 DMI，但自 2008 年以来只有 3%的人接受过芬太尼处方。在死亡前一个月观察到的氯硝西泮一致性最高（43.6%）。
总体而言，CS 配药历史与中毒死亡中涉及的药物之间的一致性较低，这表明需要重新评估处方药物暴露与过量死亡之间的复杂关系，并扩大医疗保健系统内外的减少伤害干预措施，以降低药物中毒死亡率。
