Bazazi Alexander R, Low Patrick, Gomez Bryson O, Snyder Hannah, Hom Jeffrey K, Soran Christine S, Zevin Barry, Mason Michael, Graterol Joseph, Coffin Phillip O
Division of Substance Abuse and Addiction Medicine at San Francisco General Hospital, Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.
Department of Family and Community Medicine, University of California San Francisco, 995 Potrero Ave, San Francisco, CA, 94110, USA.
J Urban Health. 2024 Apr;101(2):245-251. doi: 10.1007/s11524-024-00852-0. Epub 2024 Apr 3.
Fentanyl-mixed and substituted heroin is well-documented, but less is known about unintentional fentanyl use among people using stimulants. To determine the prevalence of and racial and ethnic disparities in unintentional fentanyl use among people experiencing a medically attended opioid overdose, we reviewed 448 suspected non-fatal overdose cases attended by a community paramedic overdose response team in San Francisco from June to September 2022. We applied a case definition for opioid overdose to paramedic records and abstracted data on intended substance use prior to overdose. Among events meeting case criteria with data on intended substance use, intentional opioid use was reported by 57.3%, 98.0% of whom intended to use fentanyl. No intentional opioid use was reported by 42.7%, with most intending to use stimulants (72.6%), including methamphetamine and cocaine. No intentional opioid use was reported by 58.5% of Black, 52.4% of Latinx, and 28.8% of White individuals (p = 0.021), and by 57.6% of women and 39.5% of men (p = 0.061). These findings suggest that unintentional fentanyl use among people without opioid tolerance may cause a significant proportion of opioid overdoses in San Francisco. While intentional fentanyl use might be underreported, the magnitude of self-reported unintentional use merits further investigation to confirm this phenomenon, explore mechanisms of use and disparities by race and ethnicity, and deploy targeted overdose prevention interventions.
芬太尼混合及替代海洛因的情况已有充分记录，但对于使用兴奋剂人群中无意使用芬太尼的情况了解较少。为了确定在接受医疗救治的阿片类药物过量使用者中无意使用芬太尼的患病率以及种族和族裔差异，我们回顾了2022年6月至9月期间旧金山社区护理人员过量用药应对小组处理的448例疑似非致命过量用药病例。我们将阿片类药物过量的病例定义应用于护理人员记录，并提取了过量用药前预期使用物质的数据。在符合病例标准且有预期使用物质数据的事件中，57.3%报告有意使用阿片类药物，其中98.0%有意使用芬太尼。42.7%未报告有意使用阿片类药物，其中大多数有意使用兴奋剂（72.6%），包括甲基苯丙胺和可卡因。58.5%的黑人、52.4%的拉丁裔和28.8%的白人未报告有意使用阿片类药物（p = 0.021），57.6%的女性和39.5%的男性未报告有意使用阿片类药物（p = 0.061）。这些发现表明，在旧金山，无阿片类药物耐受性人群中无意使用芬太尼可能导致相当比例的阿片类药物过量。虽然有意使用芬太尼的情况可能报告不足，但自我报告的无意使用程度值得进一步调查，以确认这一现象，探索使用机制以及种族和族裔差异，并部署有针对性的过量用药预防干预措施。
