Center for Social Medicine and Humanities, University of California, Los Angeles, California, USA.
Division of General Internal Medicine and Health Service Research, University of California, Los Angeles, California, USA.
Addiction. 2023 Dec;118(12):2477-2485. doi: 10.1111/add.16318. Epub 2023 Sep 13.
To characterize polysubstance death in the United States during the transition to the fourth wave of the drug overdose crisis. To characterize co-involved substances in fatal overdose involving synthetic opioids (mainly illicitly manufactured fentanyl analogues) by year, state, and intersectional sociodemographic groups.
Population-based study of national death records.
United States.
PARTICIPANTS/CASES: All people who died from drug overdose in the United States between 2010 and 2021.
Percentage of all fatal overdose involving fentanyls, stimulants, and other drugs. Most commonly co-involved substances in fentanyl overdose by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by intersectional region, race/ethnicity, age, and sex.
The percent of US overdose deaths involving both fentanyl and stimulants increased from 0.6% (n = 235) in 2010 to 32.3% (34 429) in 2021, with the sharpest rise starting in 2015. In 2010, fentanyl was most commonly found alongside prescription opioids, benzodiazepines, and alcohol. In the Northeast this shifted to heroin-fentanyl co-involvement in the mid-2010s, and nearly universally to cocaine-fentanyl co-involvement by 2021. Universally in the West, and in the majority of states in the South and Midwest, methamphetamine-fentanyl co-involvement predominated by 2021. The proportion of stimulant involvement in fentanyl-involved overdose deaths rose in virtually every state 2015-2021. Intersectional group analysis reveals particularly high rates for older Black and African American individuals living in the West.
By 2021 stimulants were the most common drug class found in fentanyl-involved overdoses in every state in the US. The rise of deaths involving cocaine and methamphetamine must be understood in the context of a drug market dominated by illicit fentanyls, which have made polysubstance use more sought-after and commonplace. The widespread concurrent use of fentanyl and stimulants, as well as other polysubstance formulations, presents novel health risks and public health challenges.
描述美国在第四波药物过量危机过渡期间的多物质死亡情况。按年份、州和交叉社会人口统计学群体描述涉及合成阿片类药物（主要是非法制造的芬太尼类似物）的致命过量中涉及的共同物质。
全国死亡记录的基于人群的研究。
美国。
参与者/病例：2010 年至 2021 年间在美国死于药物过量的所有人。
所有涉及芬太尼、兴奋剂和其他药物的致命过量的百分比。按州和年份列出的芬太尼过量中最常见的共同物质。按州和年份列出的涉及芬太尼过量的致命兴奋剂的百分比。按交叉区域、种族/族裔、年龄和性别列出的涉及芬太尼过量的致命兴奋剂的百分比。
涉及芬太尼和兴奋剂的美国药物过量死亡百分比从 2010 年的 0.6%（n=235）增加到 2021 年的 32.3%（34429），从 2015 年开始急剧上升。2010 年，芬太尼最常与处方阿片类药物、苯二氮䓬类药物和酒精一起发现。在东北部，这种情况在 2010 年代中期转变为海洛因-芬太尼共同涉及，到 2021 年几乎普遍转变为可卡因-芬太尼共同涉及。在西部，几乎在所有州，以及在南部和中西部的大多数州，到 2021 年，甲基苯丙胺-芬太尼共同涉及占主导地位。2015 年至 2021 年，几乎每个州的兴奋剂在涉及芬太尼的过量死亡中的参与比例都有所上升。交叉群体分析显示，居住在西部的老年黑人和非裔美国人的比例特别高。
到 2021 年，兴奋剂已成为美国每个州涉及芬太尼过量的最常见药物类别。涉及可卡因和甲基苯丙胺的死亡人数的增加必须在非法芬太尼主导的毒品市场背景下加以理解，这使得多物质使用更受欢迎和常见。芬太尼和兴奋剂以及其他多物质制剂的广泛同时使用带来了新的健康风险和公共卫生挑战。
