Hasgul Zeynep, Deutsch Arielle R, Jalali Mohammad S, Stringfellow Erin J
MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, 02144, USA.
Avera Research Institute, Avera Health, Sioux Falls, South Dakota, 57108, USA.
Int J Drug Policy. 2025 Feb;136:104702. doi: 10.1016/j.drugpo.2025.104702. Epub 2025 Jan 26.
The overdose epidemic in the United States is evolving, with a rise in stimulant (cocaine and/or methamphetamine)-only and opioid and stimulant-involved overdose deaths for reasons that remain unclear. We conducted interviews and group model building workshops in Massachusetts and South Dakota. Building on these data and extant research, we identified six dynamic hypotheses, explaining changes in stimulant-involved overdose trends, visualized using causal loop diagrams. For stimulant- and opioid-involved overdose deaths, three dynamic hypotheses emerged: (1) accidental exposure to fentanyl from stimulants; (2) primary stimulant users increasingly using opioids, often with resignation; (3) primary opioid (especially fentanyl) users increasingly using stimulants to balance the sedating effect of fentanyl. For stimulant-only overdose deaths, three additional dynamic hypotheses emerged: (1) disbelief that death could occur from stimulants alone, and doubt in testing capabilities to detect fentanyl; (2) the stimulant supply has changed, leading to higher unpredictability and thus higher overdose risk; and (3) long-term stimulant use contributing to deteriorating health and increasing overdose risk. These hypotheses likely each explain a portion of the recent trends in stimulant-involved overdoses. However, confusion and uncertainty around the drug supply emerged as a central theme, underscoring the chaotic and unpredictable nature of the stimulant market. Our findings indicate the need for research to develop targeted public health interventions, including analyzing the extent of the effect of contamination on overdoses, reducing confusion about the stimulant supply, and examining historical stimulant use trends.
美国的药物过量流行情况正在演变，仅使用兴奋剂（可卡因和/或甲基苯丙胺）以及涉及阿片类药物和兴奋剂的过量死亡人数有所增加，原因尚不清楚。我们在马萨诸塞州和南达科他州进行了访谈和群体模型构建研讨会。基于这些数据和现有研究，我们确定了六个动态假设，解释了涉及兴奋剂的过量趋势变化，并使用因果循环图进行了可视化展示。对于涉及兴奋剂和阿片类药物的过量死亡，出现了三个动态假设：（1）因兴奋剂意外接触芬太尼；（2）主要使用兴奋剂的人群越来越多地使用阿片类药物，且往往听之任之；（3）主要使用阿片类药物（尤其是芬太尼）的人群越来越多地使用兴奋剂来平衡芬太尼的镇静作用。对于仅使用兴奋剂的过量死亡，又出现了另外三个动态假设：（1）怀疑仅使用兴奋剂会导致死亡，且对检测芬太尼的测试能力存疑；（2）兴奋剂供应发生了变化，导致更高的不可预测性，从而增加了过量风险；（3）长期使用兴奋剂导致健康状况恶化，增加了过量风险。这些假设可能各自解释了近期涉及兴奋剂的过量用药趋势的一部分。然而，围绕药物供应的混乱和不确定性成为一个核心主题，凸显了兴奋剂市场的混乱和不可预测性。我们的研究结果表明需要开展研究以制定有针对性的公共卫生干预措施，包括分析污染对过量用药的影响程度、减少对兴奋剂供应的困惑以及研究兴奋剂的历史使用趋势。
