Tomko Catherine, Park Ju Nyeong, Amin-Esmaeili Masoumeh, Schneider Kristin, Susukida Ryoko, Byregowda Himani, Parnham Taylor, Johnson Renee M
Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
Brown University, Providence, Rhode Island, USA.
Inj Prev. 2025 Jan 11. doi: 10.1136/ip-2024-045277.
In 2020, Maryland had the fourth-highest opioid overdose mortality rate in the USA. We describe substances identified in postmortem toxicology screening and designated as cause of death (COD) for overdose decedents in Maryland, including specific combinations of substances designated as COD.
We performed a retrospective analysis of N=5442 adult overdose decedents (ie, manner of death unintentional or undetermined) in Maryland between January 2020 and December 2021. Overdose mortality data from the State Unintentional Drug Overdose Reporting System. Substances were categorised into five major categories: opioids, alcohol, psychostimulants, sedative-hypnotics and psychotropic drugs. Opioids were further divided into prescription opioids (eg, oxycodone, methadone, tramadol) and illicit opioids (eg, illicitly manufactured fentanyl (IMF), heroin).
Opioids were present in 93% of cases and designated as COD for 92%. IMF was the predominant opioid designated as COD (82% of cases), whereas heroin was COD in only 3%. Psychostimulants, predominantly cocaine, were present in 48% of cases and designated as COD in 41%. Opioids alone were COD in 39% of cases, opioids and psychostimulants in combination were COD for 27%, followed by opioids and alcohol (9%), opioids, alcohol and psychostimulants (6%), and opioids and sedative-hypnotics (4%).
IMF is, by far, the leading cause of overdose in Maryland. For more than one-quarter of decedents, opioids and psychostimulants in combination were COD. Specific drug combinations have implications for public health surveillance and harm reduction efforts to keep people who use drugs safer from a volatile drug market and potential fatal overdose.
2020年，马里兰州的阿片类药物过量死亡率在美国排名第四。我们描述了在尸检毒理学筛查中确定的、被指定为马里兰州过量死亡者死因（COD）的物质，包括被指定为COD的特定物质组合。
我们对2020年1月至2021年12月期间马里兰州N = 5442名成年过量死亡者（即死亡方式为意外或不明）进行了回顾性分析。过量死亡数据来自州意外药物过量报告系统。物质被分为五大类：阿片类药物、酒精、精神兴奋剂、镇静催眠药和精神药物。阿片类药物进一步分为处方阿片类药物（如羟考酮、美沙酮、曲马多）和非法阿片类药物（如非法制造的芬太尼（IMF）、海洛因）。
93%的病例中存在阿片类药物，92%被指定为COD。IMF是被指定为COD的主要阿片类药物（82%的病例），而海洛因仅占COD的3%。精神兴奋剂，主要是可卡因，在48%的病例中存在，41%被指定为COD。仅阿片类药物为COD的病例占39%，阿片类药物和精神兴奋剂联合为COD的占27%，其次是阿片类药物和酒精（9%）、阿片类药物、酒精和精神兴奋剂（6%）以及阿片类药物和镇静催眠药（4%）。
到目前为止，IMF是马里兰州过量用药的主要原因。超过四分之一的死亡者中，阿片类药物和精神兴奋剂联合为COD。特定的药物组合对公共卫生监测和减少伤害的努力有影响，以使吸毒者在不稳定的毒品市场和潜在的致命过量用药中更安全。
