合成阿片類藥物在美國全國範圍內使用增加近 800%
資料來源：Kelli Whitlock Burton / 2022 年 6 月 14 日 / Medscape / 財團法人台灣紅絲帶基金會編譯
新的研究顯示，合成阿片類藥物的使用在 7 年內增加了近 800% 一項國家尿液藥物檢測 (UDT) 研究的結果發布之際，美國報告的藥物過量死亡人數創歷史新高——其中超過 80% 涉及芬太尼或其他合成阿片類藥物，並促使推動建立更好的監測模型。研究人員發現，UDT 可用於準確識別社區中流通的藥物，在短短幾天內揭示極為重要的藥物使用趨勢，相較於當前監測方法需要一個月或更長時間才能報告。更快的週轉機制可使臨床醫生和公共衛生官員能夠更加積極主動地採取有針對性的過量預防和減害的策略，例如分發納洛酮和芬太尼試紙。
史蒂文·帕西克博士，圖片來源1：Millennium Health
「我們正在談論試圖提出一個早期預警系統」，研究作者、加利福尼亞州聖地亞哥千禧健康科學事務副總裁 Steven Passik 博士告訴 Medscape Medical News。 「我們正試圖找出是否可以讓減害和治療領域的人們提前幾週或一個月或更長時間來了解未來可能發生的情況，以便可以安排一些介入措施」。該研究於 6 月 3 日在線上發表於 JAMA Network Open 上。
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呼籲加強監測 ，2021 年美國有超過 100,000 人死於意外用藥過量，創下歷史新高，比 2020 年的數字增加了 15%，這也創下了紀錄。聯邦政府應對危機計畫的一部分包括透過更好地收集和挖掘公共衛生監測數據來加強流行病學工作。目前用於檢測藥物使用趨勢的來源包括死亡率數據、毒物控制中心、急診科、電子健康記錄和犯罪實驗室。但對這些來源的分析可能需要數週或更長時間。
麗貝卡·傑克遜博士，圖片來源2：俄亥俄州立大學
「解決和減少過量死亡的真正挑戰之一是相對缺乏可取得的即時數據，這些數據可以支持對特定地理區域內資源部署的敏捷響應」，該研究的共同作者、醫學博士、教授 Rebecca Jackson 和哥倫布市的俄亥俄州立大學臨床和轉化研究副院長告訴 Medscape 醫學新聞。俄亥俄州立大學的研究人員與美國最大的尿液檢測實驗室之一 Millennium Health 的科學家合作，進行了一項橫斷面研究，以確定 UDT 是否可以成為一種準確、更快的藥物監測工具。他們分析了 2013 年至 2020 年所有 50 個州物質使用障礙 (SUD) 治療設施中患者的 500,000 份獨特尿液樣本，將樣本中發現的可卡因、海洛因、甲基安非他命、合成阿片類藥物和其他阿片類藥物的水平與來自國家生命統計系統中藥物過量死亡數據中的國家、州和縣級相同藥物之水平進行了比較。在國家級層面，合成阿片類藥物和甲基安非他命與過量死亡率數據高度相關（兩者的Spearman相關係數皆為 ρ = 0.96）。當合成阿片類藥物共同參與時，甲基安非他命（ρ = 0.98）、海洛因（ρ = 0.78）、可卡因（ρ = 0.94）和其他阿片類藥物（ρ = 0.83）也與過量死亡率數據高度相關。在檢查來自 24 個州的州級數據時和透過對俄亥俄州 19 個縣的縣級分析時亦發現了類似的相關性。
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不斷變化的格局
研究人員表示，合成阿片類藥物和甲基安非他命的過量死亡與尿液藥物檢測 (UDT) 結果之間的強相關性很可能是由藥物的可獲得性和致死性來解釋的。
佩恩·惠特利，圖片 3來源：Millennium Health
「我們發現的最重要的事情就是相關性的強度，這正是我們認為相關性如此重要的核心」，主要作者、千禧年健康生物信息學高級主任、文學士 Penn Whitley 告訴 Medscape醫學新聞。 「我們需要證明 UDT 陽性率與死亡率之間存在很強的相關性——在這種情況下，致命的藥物過量率——可以利用 UDT 作為即時數據源作為構建工具的墊腳石」。雖然該研究的主要目標是建立 UDT 結果與國家死亡率數據之間的相關性，但該研究還提供了對阿片類藥物流行情況不斷變化的看法。總體而言，總合成阿片類藥物的 UDT 陽性率從 2013 年的 2.1% 增加到 2020 年的 19.1%（增加了 792.5%）。當存在合成阿片類藥物時，所有包含藥物類別的陽性率均有所增加。然而，在沒有合成阿片類藥物的情況下，從 2013 年到 2020 年，幾乎所有藥物類別的 UDT 陽性率均下降（可卡因為 7.7% 至 4.7%；海洛因為 3.9% 至 1.6%；其他阿片類藥物為 20.5% 至 6.9%）。僅只有甲基安非他命陽性之增加則不論涉及或不涉及合成阿片類藥物均增加。使用合成阿片類藥物後，甲基安非他命的陽性率從 2013 年的 0.1% 上升到 2020 年的 7.9%。沒有它們，甲基安非他命的陽性率仍然上升，從 2013 年的 2.1% 上升到 2020 年的 13.1%。調查結果與較早的一項研究一致，顯示甲基安非他命過量服用2011 年至 2018 年期間死亡人數急劇上升。「這份手稿中的數據支持阿片類藥物流行病正在從阿片類藥物流行病轉變為多物質流行病，其中非法合成阿片類藥物（主要是芬太尼）與其他物質的結合現在占到 80% 以上藥物過量 (OD) 死亡」，傑克遜說。在隨附的社論中，科羅拉多大學醫學院內科臨床教授 Jeffrey Brent 醫學博士和國家藥物濫用研究所轉化成癮醫學分部臨床醫師 Stephanie T. Weiss 醫學博士表示，隨著新藥劑的出現，將需要不同的減害策略，並補充說擁有一個即時工具來識別趨勢將是預防死亡的關鍵。
在2022/6/25 https://www.medscape.com/viewarticle/975544_print 2/2 中，「與非法藥物使用有關的監控系統是降低發病率和死亡率的重要組成部分。在地方、區域和國家層面，需要此類信息才能最有效地分配有限的資源，以最大限度地提高利益並挽救生命」，布倫特和韋斯寫道。該研究由千禧年健康和國家促進轉化科學中心資助。原始文章中包含完整的披露，但沒有消息來源報告與研究相關的利益衝突。
JAMA 網絡公開。 2022 年 6 月 3 日在線上發布。全文，社論
Medscape 醫學新聞 © 2022 WebMD, LLC
引用：合成阿片類藥物在全國範圍內使用增加近 800% – Medscape – 2022 年 6 月 14 日
Synthetic Opioid Use Up Almost 800% Nationwide
資料來源：Kelli Whitlock Burton / June 14, 2022 / Medscape
Synthetic opioid use increased by almost 800% over 7 years, new research shows The results of a national urine drug test (UDT) study come as the US is reporting a record-high number of drug overdose deaths — more than 80% of which involved fentanyl or other synthetic opioids and prompting a push for better surveillance models. Researchers found that UDTs can be used to accurately identify which drugs are circulating in a community, revealing in just a matter of days critically important drug use trends that current surveillance methods take a month or longer to report. The faster turnaround could potentially allow clinicians and public health officials to be more proactive with targeted overdose prevention and harm-reduction strategies such as distribution of naloxone and fentanyl test strips.
Dr Steven Passik
“We’re talking about trying to come up with an early warning system,” study author Steven Passik, PhD, vice president for scientific affairs for Millennium Health, San Diego, California, told Medscape Medical News. “We’re trying to find out if we can let people in the harm reduction and treatment space know about what might be coming weeks or a month or more in advance so that some interventions could be marshalled.” The study was published online June 3 in JAMA Network Open.
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Call for Better Surveillance More than 100,000 people in the US died of an unintended drug overdose in 2021, a record high and a 15% increase over 2020 figures, which also set a record. Part of the federal government’s plan to address the crisis includes strengthening epidemiologic efforts by better collection and mining of public health surveillance data. Sources currently used to detect drug use trends include mortality data, poison control centers, emergency departments, electronic health records, and crime laboratories. But analysis of these sources can take weeks or more.
Dr Rebecca Jackson
“One of the real challenges in addressing and reducing overdose deaths has been the relative lack of accessible real-time data that can support agile responses to deployment of resources in a specific geographic region,” study co-author Rebecca Jackson, MD, professor and associate dean for Clinical and Translational Research at Ohio State University in Columbus, told Medscape Medical News. Ohio State researchers partnered with scientists at Millennium Health, one of the largest urine test labs in the US, on a cross-sectional study to find out if UDTs could be an accurate and speedier tool for drug surveillance. They analyzed 500,000 unique urine samples from patients in substance use disorder (SUD) treatment facilities in all 50 states from 2013-2020, comparing levels of cocaine, heroin, methamphetamine, synthetic opioids, and other opioids found in the samples to levels of the same drugs from overdose mortality data at the national, state, and county level from the National Vital Statistics System. On a national level, synthetic opioids and methamphetamine were highly correlated with overdose mortality data (Spearman ρ = 0.96 for both). When synthetic opioids were co-involved, methamphetamine (ρ = 0.98), heroin (ρ = 0.78), cocaine (ρ= 0.94), and other opioids (ρ = 0.83) were also highly correlated with overdose mortality data. Similar correlations were found when examining state-level data from 24 states and at the county level upon analysis of 19 counties in Ohio.
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A Changing Landscape
Researchers said the strong correlation between overdose deaths and UDT results for synthetic opioids and methamphetamine are likely explained by the drugs’ availability and lethality.
Penn Whitley
“The most important thing that we found was just the strength of the correlation, which goes right to the heart of why we considered correlation to be so critical,” lead author Penn Whitley, BA, senior director of bioinformatics for Millennium Health, told Medscape Medical News. “We needed to demonstrate that there was a strong correlation of just the UDT positivity rates with mortality — in this case, fatal drug overdose rates — as a steppingstone to build out tools that could utilize UDT as a real-time data source.” While the main goal of the study was to establish correlation between UDT results and national mortality data, the study also offers a view of a changing landscape in the opioid epidemic. Overall, UDT positivity for total synthetic opioids increased from 2.1% in 2013 to 19.1% in 2020 (a 792.5% increase). Positivity rates for all included drug categories increased when synthetic opioids were present. However, in the absence of synthetic opioids, UDT positivity decreased for almost all drug categories from 2013 to 2020 (7.7% to 4.7% for cocaine; 3.9% to 1.6% for heroin; 20.5% to 6.9% for other opioids). Only methamphetamine positivity increased with or without involvement of synthetic opioids. With synthetic opioids, meth positivity rose from 0.1% in 2013 to 7.9% in 2020. Without them, meth positivity rates still rose, from 2.1% in 2013 to 13.1% in 2020. The findings track with an earlier study showing methamphetamine-involved overdose deaths rose sharply between 2011 and 2018. “The data from this manuscript support that the opioid epidemic is transitioning from an opioid epidemic to a polysubstance epidemic where illicit synthetic opioids, largely fentanyl, in combination with other substances are now responsible for upwards of 80% of OD deaths,” Jackson said. In an accompanying editorial Jeffrey Brent, MD, PhD, clinical professor in internal medicine at the University of Colorado School of Medicine and Stephanie T. Weiss, MD, PhD, staff clinician in the Translational Addiction Medicine Branch at the National Institute on Drug Abuse note that as new agents emerge, different harm reduction strategies will be needed, adding that having a real-time tool to identify the trends will be key to o preventing deaths.
2022/6/25 https://www.medscape.com/viewarticle/975544_print 2/2 “Surveillance systems are an integral component of reducing morbidity and mortality associated with illicit drug use. On local, regional, and national levels, information of this type is needed to most efficiently allocate limited resources to maximize benefit and save lives,” Brent and Weiss write. The study was funded by Millennium Health and the National Center for Advancing Translational Sciences. Full disclosures are included in the original articles, but no sources reported conflicts related to the study.
JAMA Netw Open. Published online June 3, 2022. Full text, Editorial
Credit: Lead image: The Image bank Image 1: Millennium Health Image 2: Ohio State University Image 3: Millennium Health
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Cite this: Synthetic Opioid Use Up Almost 800% Nationwide – Medscape – Jun 14, 2022