Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Department of Mental Health Law and Policy (MHC 2636), College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States.
Front Public Health. 2024 May 27;12:1366161. doi: 10.3389/fpubh.2024.1366161. eCollection 2024.
Globally, overdose deaths increased near the beginning of the COVID-19 pandemic, which created availability and access barriers to addiction and social services. Especially in times of a crisis like a pandemic, local exposures, service availability and access, and system responses have major influence on people who use drugs. For policy makers to be effective, an understanding at the local level is needed.
This retrospective epidemiologic study from 2019 through 2021 compares immediate and 20-months changes in overdose deaths from the pandemic start to 16 months before its arrival in Pinellas County, FL We examine toxicologic death records of 1,701 overdoses to identify relations with interdiction, and service delivery.
There was an immediate 49% increase (95% CI 23-82%, < 0.0001) in overdose deaths in the first month following the first COVID deaths. Immediate increases were found for deaths involving alcohol (171%), heroin (108%), fentanyl (78%), amphetamines (55%), and cocaine (45%). Overdose deaths remained 27% higher (CI 4-55%, = 0.015) than before the pandemic through 2021.Abrupt service reductions occurred when the pandemic began: in-clinic methadone treatment dropped by two-thirds, counseling by 38%, opioid seizures by 29%, and drug arrests by 56%. Emergency transport for overdose and naloxone distributions increased at the pandemic onset (12%, 93%, respectively) and remained higher through 2021 (15%, 377%,). Regression results indicate that lower drug seizures predicted higher overdoses, and increased 911 transports predicted higher overdoses. The proportion of excess overdose deaths to excess non-COVID deaths after the pandemic relative to the year before was 0.28 in Pinellas County, larger than 75% of other US counties.
Service and interdiction interruptions likely contributed to overdose death increases during the pandemic. Relaxing restrictions on medical treatment for opioid addiction and public health interventions could have immediate and long-lasting effects when a major disruption, such as a pandemic, occurs. County level data dashboards comprised of overdose toxicology, and interdiction and service data, can help explain changes in overdose deaths. As a next step in predicting which policies and practices will best reduce local overdoses, we propose using simulation modeling with agent-based models to examine complex interacting systems.
在全球范围内，COVID-19 大流行初期的过量死亡人数有所增加，这给成瘾和社会服务的可及性和获取造成了障碍。特别是在像大流行这样的危机时期，当地暴露、服务可及性和获取以及系统反应对吸毒者有重大影响。为了使政策制定者有效，需要在当地层面进行了解。
本研究是一项回顾性的流行病学研究，对 2019 年至 2021 年期间佛罗里达州皮内拉斯县 COVID-19 大流行前后 16 个月的过量死亡即刻变化和 20 个月的变化进行了比较。我们检查了 1701 例过量用药的毒理学死亡记录，以确定与干预和服务提供有关的关系。
在 COVID-19 死亡后的第一个月，过量死亡人数立即增加了 49%（95%CI 23-82%，<0.0001）。涉及酒精（171%）、海洛因（108%）、芬太尼（78%）、苯丙胺（55%）和可卡因（45%）的死亡人数立即增加。到 2021 年，与大流行前相比，过量死亡人数仍高出 27%（CI 4-55%，=0.015）。大流行开始时，服务突然减少：门诊美沙酮治疗减少了三分之二，咨询减少了 38%，阿片类药物缉获减少了 29%，毒品逮捕减少了 56%。大流行开始时，过量用药的急救转运和纳洛酮分发增加（分别为 12%和 93%），并一直持续到 2021 年（分别为 15%和 377%）。回归结果表明，药物缉获量较低预示着过量用药增加，911 次转运增加预示着过量用药增加。与大流行前一年相比，皮内拉斯县大流行后过量死亡与非 COVID 死亡的超额比例为 0.28，高于美国其他 75%的县。
服务和干预中断可能是大流行期间过量死亡人数增加的原因。在发生重大干扰（如大流行）时，放宽对阿片类药物成瘾的医疗治疗和公共卫生干预措施的限制可能会产生即时和持久的影响。由过量用药毒理学、干预和服务数据组成的县级数据仪表板，可以帮助解释过量死亡人数的变化。作为预测哪些政策和做法最能降低当地过量死亡人数的下一步，我们建议使用基于代理的模型进行模拟建模，以检查复杂的相互作用系统。
