Charting the fourth wave: Geographic, temporal, race/ethnicity and demographic trends in polysubstance fentanyl overdose deaths in the United States, 2010–2021

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2023-09-13 DOI:10.1111/add.16318

Joseph Friedman, Chelsea L. Shover

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Abstract

Aims

To characterize polysubstance death in the United States during the transition to the fourth wave of the drug overdose crisis. To characterize co-involved substances in fatal overdose involving synthetic opioids (mainly illicitly manufactured fentanyl analogues) by year, state, and intersectional sociodemographic groups.

Design

Population-based study of national death records.

Setting

United States.

Participants/cases

All people who died from drug overdose in the United States between 2010 and 2021.

Measurements

Percentage of all fatal overdose involving fentanyls, stimulants, and other drugs. Most commonly co-involved substances in fentanyl overdose by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by intersectional region, race/ethnicity, age, and sex.

Findings

The percent of US overdose deaths involving both fentanyl and stimulants increased from 0.6% (n = 235) in 2010 to 32.3% (34 429) in 2021, with the sharpest rise starting in 2015. In 2010, fentanyl was most commonly found alongside prescription opioids, benzodiazepines, and alcohol. In the Northeast this shifted to heroin-fentanyl co-involvement in the mid-2010s, and nearly universally to cocaine-fentanyl co-involvement by 2021. Universally in the West, and in the majority of states in the South and Midwest, methamphetamine-fentanyl co-involvement predominated by 2021. The proportion of stimulant involvement in fentanyl-involved overdose deaths rose in virtually every state 2015–2021. Intersectional group analysis reveals particularly high rates for older Black and African American individuals living in the West.

Conclusions

By 2021 stimulants were the most common drug class found in fentanyl-involved overdoses in every state in the US. The rise of deaths involving cocaine and methamphetamine must be understood in the context of a drug market dominated by illicit fentanyls, which have made polysubstance use more sought-after and commonplace. The widespread concurrent use of fentanyl and stimulants, as well as other polysubstance formulations, presents novel health risks and public health challenges.

Abstract Image

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绘制第四波：2010-2021年美国多物质芬太尼过量死亡的地理、时间、种族/民族和人口趋势。

目的：描述美国在向第四波药物过量危机过渡期间的多物质死亡。按年份、州和跨部门社会人口群体描述涉及合成阿片类药物（主要是非法制造的芬太尼类似物）的致命过量的共同参与物质。设计：基于人口的国家死亡记录研究。背景：美国。参与者/病例：2010年至2021年间美国所有死于药物过量的人。测量：芬太尼、兴奋剂和其他药物的所有致命过量的百分比。按州和年份划分，芬太尼过量中最常见的共同参与物质。按州和年份分列的致命芬太尼过量并涉及兴奋剂的百分比。按跨部门地区、种族/民族、年龄和性别划分的致命芬太尼过量联合使用兴奋剂的百分比。调查结果：美国芬太尼和兴奋剂过量致死的比例从0.6%（n = 235）降至2010年的32.3%（34 429），2015年增长最快。2010年，芬太尼最常见于处方阿片类药物、苯二氮卓类药物和酒精。在东北部，这在2010年代中期转向海洛因-芬太尼的共同参与，到2021年几乎普遍转向可卡因-芬太尼的联合参与。到2021年，在西部以及南部和中西部的大多数州，甲基苯丙胺-芬太尼的共同参与占主导地位。2015-2021年，几乎每个州芬太尼过量致死中兴奋剂的比例都有所上升。跨部门群体分析显示，生活在西方的老年黑人和非裔美国人的发病率特别高。结论：到2021年，兴奋剂是美国各州芬太尼类药物中最常见的过量使用。必须在非法芬太尼主导的毒品市场背景下理解可卡因和甲基苯丙胺死亡人数的增加，这使得多物质的使用更加受欢迎和普遍。芬太尼和兴奋剂以及其他多物质制剂的广泛同时使用，带来了新的健康风险和公共卫生挑战。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.