Santaella-Tenorio Julian, Rivera-Aguirre Ariadne, Hepler Staci A, Kline David M, Cantor Jonathan, DeYoreo Maria, Martins Silvia S, Krawczyk Noa, Cerda Magdalena
From the Department of Population Health, Center for Opioid Epidemiology and Policy, NYU Grossman School of Medicine, NY.
Department of Statistical Sciences, Wake Forest University, Winston-Salem, NC.
Epidemiology. 2025 Mar 1;36(2):186-195. doi: 10.1097/EDE.0000000000001816. Epub 2023 Nov 22.
Medications for opioid use disorder are associated with a lower risk of drug overdoses at the individual level. However, little is known about whether these effects translate to population-level reductions. We investigated whether county-level efforts to increase access to medication for opioid use disorder in 2012-2014 were associated with opioid overdose deaths in New York State during the first years of the synthetic opioid crisis.
We performed an ecologic county-level study including data from 60 counties (2010-2018). We calculated rates of people receiving medication for opioid use disorder among the population misusing opioids in 2012-2014 and categorized counties into quartiles of this exposure. We modeled synthetic and nonsynthetic opioid overdose death rates using Bayesian hierarchical models.
Counties with higher rates of receiving medications for opioid use disorder in 2012-2014 had lower synthetic opioid overdose deaths in 2016 (highest vs. lowest quartile: rate ratio [RR] = 0.33, 95% credible interval [CrI] = 0.12, 0.98; and second-highest vs. lowest: RR = 0.20, 95% CrI = 0.07, 0.59) and 2017 (quartile second-highest vs. lowest: RR = 0.22, 95% CrI = 0.06, 0.83), but not 2018. There were no differences in nonsynthetic opioid overdose death rates comparing higher quartiles versus lowest quartile of exposure.
A spatio-temporal modeling approach incorporating counts of the population misusing opioids provided information about trends and interventions in the target population. Higher rates of receiving medications for opioid use disorder in 2012-2014 were associated with lower rates of synthetic opioid overdose deaths early in the crisis.
用于阿片类物质使用障碍的药物在个体层面与药物过量风险较低相关。然而，对于这些效果是否能转化为人群层面的减少情况，人们知之甚少。我们调查了2012 - 2014年县级层面为增加阿片类物质使用障碍药物可及性所做的努力与纽约州在合成阿片类物质危机头几年的阿片类药物过量死亡之间是否存在关联。
我们进行了一项县级生态研究，纳入了60个县（2010 - 2018年）的数据。我们计算了2012 - 2014年在滥用阿片类物质人群中接受阿片类物质使用障碍药物治疗的人员比例，并将各县按该暴露水平分为四分位数。我们使用贝叶斯分层模型对合成和非合成阿片类药物过量死亡率进行建模。
2012 - 2014年接受阿片类物质使用障碍药物治疗比例较高的县，在2016年合成阿片类药物过量死亡人数较少（最高四分位数与最低四分位数相比：率比[RR]=0.33，95%可信区间[CrI]=0.12，0.98；第二高四分位数与最低四分位数相比：RR = 0.20，95% CrI = 0.07，0.59）以及2017年（第二高四分位数与最低四分位数相比：RR = 0.22，95% CrI = 0.06，0.83），但在2018年没有差异。比较暴露水平较高四分位数与最低四分位数时，非合成阿片类药物过量死亡率没有差异。
一种纳入滥用阿片类物质人群计数的时空建模方法提供了有关目标人群趋势和干预措施的信息。2012 - 2014年接受阿片类物质使用障碍药物治疗的比例较高与危机早期合成阿片类药物过量死亡率较低相关。
