改进对美国阿片类药物使用障碍患病率的估计:修订 Keyes et al.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Tse Yang Lim, Katherine M Keyes, Jonathan P Caulkins, Erin J Stringfellow, Magdalena Cerdá, Mohammad S Jalali
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引用次数: 0

摘要

目标:美国面临着持续的吸毒过量危机,但有关阿片类药物使用障碍(OUD)患病率的准确信息仍然有限。Keyes 等人最近的一项分析使用乘数法和药物中毒死亡率数据来估算 OUD 患病率。尽管该方法很有见地,但在解释死亡率数据时,特别是涉及合成类阿片(SO)和不涉及类阿片的死亡率时,做出了严格且部分不一致的假设。我们对该方法和由此得出的估计值进行了修订,以解决不一致的问题,并研究了几种替代假设:我们对 Keyes 及其同事的估算方法进行了四项调整:(A) 修订了 SO 对死亡率影响的计算公式,(B) 纳入了芬太尼流行率数据,为 SO 致死率的估算提供依据,(C) 使用涉及阿片类药物的药物中毒数据估算 OUD 流行率的合理范围,(D) 调整死亡率数据,以考虑涉及阿片类药物的报告不足的情况:结果:在使用 Keyes 及其同事关于 OUD 患者占所有致命药物中毒的最初假设的同时,修订估算方程和 SO 致死效应(修正 A 和 B)可得出略高的估算值,OUD 人口在 2016 年达到 930 万,到 2019 年降至 760 万。仅使用阿片类药物中毒数据(修正 C 和 D)得出的范围较低,2014-2015 年达到峰值 640 万,2019 年降至 380 万:结论:提出的修订估算公式是可行的,解决了早期方法的局限性,因此应在未来的估算中使用。围绕药物中毒数据的其他假设也可为 OUD 人口提供合理的估计范围。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improving Estimates of the Prevalence of Opioid Use Disorder in the United States: Revising Keyes et al.

Objectives: The United States faces an ongoing drug overdose crisis, but accurate information on the prevalence of opioid use disorder (OUD) remains limited. A recent analysis by Keyes et al used a multiplier approach with drug poisoning mortality data to estimate OUD prevalence. Although insightful, this approach made stringent and partly inconsistent assumptions in interpreting mortality data, particularly synthetic opioid (SO)-involved and non-opioid-involved mortality. We revise that approach and resulting estimates to resolve inconsistencies and examine several alternative assumptions.

Methods: We examine 4 adjustments to Keyes and colleagues' estimation approach: (A) revising how the equations account for SO effects on mortality, (B) incorporating fentanyl prevalence data to inform estimates of SO lethality, (C) using opioid-involved drug poisoning data to estimate a plausible range for OUD prevalence, and (D) adjusting mortality data to account for underreporting of opioid involvement.

Results: Revising the estimation equation and SO lethality effect (adj. A and B) while using Keyes and colleagues' original assumption that people with OUD account for all fatal drug poisonings yields slightly higher estimates, with OUD population reaching 9.3 million in 2016 before declining to 7.6 million by 2019. Using only opioid-involved drug poisoning data (adj. C and D) provides a lower range, peaking at 6.4 million in 2014-2015 and declining to 3.8 million in 2019.

Conclusions: The revised estimation equation presented is feasible and addresses limitations of the earlier method and hence should be used in future estimations. Alternative assumptions around drug poisoning data can also provide a plausible range of estimates for OUD population.

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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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