Humphrey Jamie L, Schwab Clyde, Richardson Nicholas J, Lambdin Barrot H, Kral Alex H, Ray Bradley
RTI International, Research Triangle Park, North Carolina, USA
RTI International, Research Triangle Park, North Carolina, USA.
J Epidemiol Community Health. 2025 Jan 13;79(2):147-152. doi: 10.1136/jech-2024-222263.
The opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of increasing overdose by driving consumers towards new suppliers with unpredictable drug products of unknown potency.
Cross-sectional study using point-level information on law enforcement opioid-related drug seizures from property room data, opioid-related non-fatal overdose events from emergency medical services and block group-level social determinants of health data from multiple sources. Using an endemic-epidemic spatiotemporal regression model, we estimated the degree to which exposure to drug supply disruptions triggers future overdose events within small space-time distances in Indianapolis, Indiana.
Neighbourhoods with more structural racism, economic deprivation or urban blight were associated with higher rates of non-fatal overdose. Exposure to an opioid-related drug seizure event had a significant and positive effect on the epidemic probability of non-fatal overdose. An opioid seizure that occurred within 250 m and 3 days, 250 m and 7 days, and 250 m and 14 days of an overdose event increased the risk of a new non-fatal overdose by 2.62 (rate ratio (RR)=2.62, 95% CI 1.87 to 3.67), 2.17 (RR=2.17, 95% CI 1.87 to 2.59) and 1.83 (RR=1.83, 95% CI 1.66 to 2.02), respectively. Similar spatiotemporal patterns were observed in a smaller spatial bandwidth.
Results demonstrated that overdoses exhibit a community spread process, which is exacerbated following law enforcement strategies to disrupt the unregulated drug market. We discuss decriminalisation and increasing resources that promote safer drug use to combat this public health crisis.
美国的阿片类药物过量致死危机是一场持续的公共卫生流行病。当前执法部门打击当地非法毒品市场的策略可能会产生医源性影响，即驱使消费者转向供应具有不可预测效力的未知毒品产品的新供应商，从而增加过量用药的情况。
采用横断面研究，利用财产室数据中与执法阿片类药物相关的毒品查获点级信息、紧急医疗服务中与阿片类药物相关的非致命过量用药事件以及来自多个来源的街区组级健康社会决定因素数据。使用地方病-流行病时空回归模型，我们估计了在印第安纳州印第安纳波利斯市小时空距离内，接触毒品供应中断引发未来过量用药事件的程度。
存在更多结构性种族主义、经济贫困或城市衰败的社区与非致命过量用药率较高相关。接触与阿片类药物相关的毒品查获事件对非致命过量用药的流行概率有显著的正向影响。在过量用药事件发生的250米范围内且3天内、250米范围内且7天内以及250米范围内且14天内发生的阿片类药物查获事件，分别使新的非致命过量用药风险增加2.62倍（率比（RR）=2.62，95%置信区间1.87至3.67）、2.17倍（RR=2.17，95%置信区间1.87至2.59）和1.83倍（RR=1.83，95%置信区间1.66至2.02）。在较小的空间带宽内也观察到了类似的时空模式。
结果表明，过量用药呈现出社区传播过程，在执法部门打击非法毒品市场的策略实施后，这种情况会加剧。我们讨论了将毒品使用非刑罪化以及增加促进更安全毒品使用的资源，以应对这一公共卫生危机。
