Richardson Julia, Banks Devin E, Brown Kanila L, Nance Melissa, Carpenter Ryan W, Winograd Rachel P
Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Subst Use Addctn J. 2025 Apr 17:29767342251330411. doi: 10.1177/29767342251330411.
Fentanyl contributes to the majority of overdose deaths in the United States but the risk of fatal overdose increases when other substances are involved. Although polysubstance overdose involving fentanyl and stimulants has been characterized as increasing nationally and in urban coastal cities, little is known about patterns of drugs involved in fatal overdose in the urban Midwest.
The current study examined drug-involved death data from St. Louis City and County. Cases included were drug overdose deaths occurring from 2016 to 2021 (N = 4088; 73% male; 50% white, 49% black). Latent class analysis was used to examine prototypical patterns and demographic associations.
Results indicated fentanyl was involved in the majority (75.0%) of overdose deaths. A five-class solution best fit the data, characterized by deaths involving: predominant fentanyl (48.5%), fentanyl and heroin (20.0%), fentanyl and psychostimulants (12.8%), prescription opioid/undifferentiated (10.6%), and predominant cocaine (8.0%). Relative to predominant fentanyl, decedents in the fentanyl and heroin class and predominant cocaine class were more likely to be black (s < .05) whereas those in the fentanyl and methamphetamine class and prescription opioid/undifferentiated class were more likely to be white (s < .05). Females comprised a larger proportion of decedents in the fentanyl and heroin, predominant cocaine, and prescription opioid/undifferentiated classes (s < .05). Deaths in the predominant fentanyl class were more likely to occur in urban versus suburban environments (s < .05).
Findings diverge from previous research and national patterns highlighting the importance of local data for informing health care and policy in mid-sized and Midwest cities. Overdose prevention that addresses both intentional ingestion and unintentional ingestion of fentanyl with other substances, particularly stimulants, are warranted as its ubiquity in the drug supply persists.
在美国，芬太尼导致了大多数过量用药死亡，但当涉及其他物质时，致命过量用药的风险会增加。尽管涉及芬太尼和兴奋剂的多物质过量用药在全国范围内以及沿海城市呈上升趋势，但对于美国中西部城市致命过量用药中涉及的药物模式知之甚少。
本研究调查了圣路易斯市和圣路易斯县的涉药死亡数据。纳入的病例为2016年至2021年期间发生的药物过量死亡病例（N = 4088；73%为男性；50%为白人，49%为黑人）。采用潜在类别分析来研究典型模式和人口统计学关联。
结果表明，大多数（75.0%）过量用药死亡涉及芬太尼。五类解决方案最符合数据，其特征为涉及以下死亡情况：主要为芬太尼（48.5%）、芬太尼和海洛因（20.0%）、芬太尼和精神兴奋剂（12.8%）、处方阿片类药物/未分化（10.6%）以及主要为可卡因（8.0%）。与主要为芬太尼的情况相比，芬太尼和海洛因类别以及主要为可卡因类别的死者更有可能是黑人（P <.05），而芬太尼和甲基苯丙胺类别以及处方阿片类药物/未分化类别的死者更有可能是白人（P <.05）。在芬太尼和海洛因、主要为可卡因以及处方阿片类药物/未分化类别中，女性死者所占比例更大（P <.05）。主要为芬太尼类别的死亡更有可能发生在城市而非郊区环境中（P <.05）。
研究结果与先前的研究和全国模式不同，突出了本地数据对于为中型和中西部城市的医疗保健和政策提供信息的重要性。鉴于芬太尼在毒品供应中普遍存在，有必要开展针对芬太尼与其他物质（尤其是兴奋剂）的故意摄入和意外摄入的过量用药预防工作。
