Center for Public Health Research, San Francisco Department of Public Health, United States.
Center for Public Health Research, San Francisco Department of Public Health, United States.
Int J Drug Policy. 2024 Nov;133:104602. doi: 10.1016/j.drugpo.2024.104602. Epub 2024 Oct 5.
Drug overdose deaths increased by 50 % between 2017 and 2021 in San Francisco. Little is known about non-fatal overdose, which heralds future risk for morbidity and overdose death. We assessed non-fatal overdose, access to drug treatment, and overdose prevention service utilization among people who inject drugs (PWID) in San Francisco in 2022.
Data were from the National HIV Behavioral Surveillance (NHBS), a cross-sectional survey among PWID recruited by respondent-driven sampling from June-December 2022. Participants self-reported their experience of overall overdose. Logistic regression analysis identified factors associated with non-fatal overdose.
Of 521 PWID, 120 (23.0 %) experienced non-fatal overdose; 207 (39.7 %) frequently injected methamphetamine and 175 (33.6 %) frequently injected heroin in the past 12 months. PWID who experienced non-fatal overdose were more likely to reside in the low-income neighborhoods (25.9 % vs. other neighborhoods 16.8 %, p = 0.022) in the past 12 months. Less than half (43.7 %) of PWID who experienced non-fatal overdose received overdose treatment. Compared to those who did not try to access treatment, adjusted odds of non-fatal overdose was 1.89 times higher among PWID who attempted to access drug treatment but were unable to (p = 0.035, 95 % CI 1.05-3.43); and 1.86 times higher among PWID who attempted to obtain medications to treat drug use but were unable to in the past 12 months (p = 0.049, 95 % CI: 1.00-3.43).
Non-fatal overdose was highly prevalent among PWID, including those who frequently inject stimulants. Public health surveillance will need to be vigilant in monitoring stimulant use and tracking fentanyl contamination in non-opioid drugs. PWID who were most engaged in harm reduction practices were also the most likely to experience non-fatal overdose. Expansion of substance use and overdose treatment, naloxone, fentanyl test strips, and safe drug use education are needed to reduce risk of overdose deaths among PWID.
2017 年至 2021 年期间，旧金山的药物过量死亡人数增加了 50%。对于非致命性药物过量，人们知之甚少，它预示着未来会出现发病和药物过量死亡的风险。我们评估了 2022 年旧金山注射吸毒者 (PWID) 的非致命性药物过量、获得药物治疗以及过量预防服务的利用情况。
数据来自国家艾滋病毒行为监测 (NHBS)，这是一项于 2022 年 6 月至 12 月通过应答者驱动抽样从 PWID 中招募的横断面调查。参与者自我报告了他们的总体药物过量经历。逻辑回归分析确定了与非致命性药物过量相关的因素。
在 521 名 PWID 中，有 120 名（23.0%）经历过非致命性药物过量；207 名（39.7%）经常注射甲基苯丙胺，175 名（33.6%）经常在过去 12 个月内注射海洛因。经历过非致命性药物过量的 PWID 更有可能在过去 12 个月内居住在低收入社区（25.9% 比其他社区 16.8%，p=0.022）。经历过非致命性药物过量的 PWID 中，不到一半（43.7%）接受了药物过量治疗。与未尝试接受治疗的人相比，尝试接受药物治疗但无法获得治疗的 PWID 发生非致命性药物过量的调整后优势比为 1.89 倍（p=0.035，95%CI 1.05-3.43）；在过去 12 个月内尝试获得用于治疗药物使用的药物但无法获得的 PWID 发生非致命性药物过量的调整后优势比为 1.86 倍（p=0.049，95%CI：1.00-3.43）。
PWID 中非致命性药物过量发生率很高，包括经常注射兴奋剂的人群。公共卫生监测需要警惕监测兴奋剂的使用情况，并跟踪非阿片类药物中的芬太尼污染。最积极参与减少伤害措施的 PWID 也最有可能经历非致命性药物过量。需要扩大药物使用和过量治疗、纳洛酮、芬太尼检测条以及安全药物使用教育，以减少 PWID 中的过量死亡风险。
