"毒品中的可卡因":可卡因掺假芬太尼供应的并发症未被充分认识。

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI:10.1097/ADM.0000000000001319
Vincent Mariano, Justin Berk
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引用次数: 0

摘要

摘要:阿片类药物危机,特别是涉及芬太尼和兴奋剂的 "第四次浪潮",导致美国因吸毒过量而死亡的人数急剧增加。尽管可卡因中的芬太尼污染已引起人们的极大关注,但可卡因中掺杂芬太尼的反面却在很大程度上被忽视,尽管它对健康有影响。可卡因和芬太尼同时过量致死人数的增加可归因于各种因素,从有意使用多种物质到无意掺杂。与可卡因相关的健康问题可能会加剧这一问题。掺入可卡因的阿片类药物会增加用药过量的风险,这可能有四种途径,包括药物强化作用增强、更换药物样本可能带来用药过量风险、治疗阿片类药物使用障碍的药物代谢发生改变,以及心肌需求增加与阿片类药物引起的呼吸抑制并存。有了这些风险,在无管制的毒品市场中,药物检测就变得至关重要。随着多种物质使用过量的激增,迫切需要了解毒品供应是如何变化的,以便有效地确定适当的减低伤害策略。具体而言,需要进一步研究评估低水平可卡因暴露与长期/持久使用阿片类药物的并发症。与掺杂可卡因的芬太尼相关的危害强调了了解芬太尼在可卡因中的存在以及可卡因在芬太尼供应中的作用的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
"Coke in the Dope": The Underrecognized Complications of a Cocaine-Adulterated Fentanyl Supply.

Abstract: The opioid crisis, particularly the "fourth wave" involving fentanyl and stimulants, has been responsible for an alarming increase in overdose deaths in the United States. Although fentanyl contamination in cocaine has gained significant attention, the converse-cocaine-adulterated fentanyl-has been largely overlooked despite its health implications. The rise in concurrent cocaine and fentanyl overdose deaths could be attributed to various factors, from intentional polysubstance use to unintentional adulterations. Cocaine-related health issues may amplify the problem. Four potential pathways for the increased risk of overdose with cocaine-adulterated opioids include enhanced drug reinforcement, potential overdose risk with switching drug samples, altered metabolism of medications used for opioid use disorder, and increased myocardial demand juxtaposed with opioid-induced respiratory depression. With these risks, the importance of drug testing becomes paramount in the unregulated drug market. As polysubstance use overdoses surge, there is an urgent need to understand how drug supplies are changing in order to effectively identify appropriate harm reduction strategies. Specifically, further research is needed evaluating complications of low-level cocaine exposure with chronic/persistent opioid use. The hazards associated with cocaine-adulterated fentanyl emphasize the significance of understanding not only fentanyl's presence in cocaine but also cocaine's role in the fentanyl supply.

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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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