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IF 2.9 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Canadian Journal of Public Health-Revue Canadienne De Sante Publique Pub Date : 2025-02-24 DOI:10.17269/s41997-024-00990-7

Samuel Tobias, Jennifer Angelucci, Evan Wood, Jane A Buxton, Lianping Ti

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引用次数: 0

摘要

目的：近年来，加拿大不受管制的药品供应中充斥着新型掺杂物（如芬太尼类似物、苯二氮卓、恶嗪）。虽然芬太尼已被证明与用药过量死亡和其他非致命性健康后果有关，但与这些掺杂物相关的不良事件（AE）却鲜有描述。本研究旨在确定通过药物检查服务发现的常见掺杂物是否与吸毒者所报告的特定不良事件发生率的增加有关：方法：在不列颠哥伦比亚省的减低危害场所，使用傅立叶变换红外光谱和免疫测定条对毒品检查样本进行分析。对吸食后检查阿片类药物的人的自我报告AE（如非致命性过量、长时间镇静、癫痫发作）进行了记录。使用泊松分布的广义线性模型计算了常见掺杂物中AE的调整流行率（aPR）和95%置信区间（95% CI），并对是否存在其他掺杂物、预期药物、地理位置和月份进行了控制：2022 年 2 月至 2024 年 5 月期间，在社区站点分析了 80,415 份样本。在符合条件的样本中，36.1%为预期阿片类药物，其中 42.2%在食用后进行了检查。在 10.7% 的用药后阿片类药物检查中发现了 AE。经调整后，阿片类药物样本中苯二氮卓类药物的存在与任何 AE 发生率的增加有关（aPR 1.97；95% CI 1.70-2.27），异丙嗪的存在也与 AE 发生率的增加有关（aPR 1.50；95% CI 1.09-2.07）。考虑到具体的 AE，苯二氮卓类药物与用药过量（aPR 2.05；95% CI 1.68-2.51）和长时间镇静（aPR 3.35；95% CI 2.54-4.43）的发生率增加有关：结论：与未受管制的阿片类药物相关的非致命性AE在很大程度上尚未得到描述。我们的研究结果报告了与未受管制的阿片类药物供应中不同掺杂物相关的特定AE。有了这些信息，就可以针对这些掺杂物制定有针对性的公共卫生干预措施和服务。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Novel adulterants in unregulated opioids and their associations with adverse events.

Objective: In recent years, Canada's unregulated drug supply has become permeated by novel adulterants (e.g., fentanyl analogues, benzodiazepines, xylazine). While fentanyl has been shown to be associated with overdose mortality and other non-fatal health outcomes, adverse events (AE) associated with these adulterants remain poorly described. This study seeks to identify whether common adulterants identified through drug checking services are associated with increased prevalence of specific adverse events reportedly experienced by people who use drugs.

Methods: Drug checking samples were analyzed using Fourier-transform infrared spectroscopy and immunoassay strips at harm reduction sites in British Columbia. Self-reported AE (e.g., non-fatal overdose, prolonged sedation, seizures) were recorded from individuals who checked opioids post-consumption. Adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) of AE among common adulterants were calculated using generalized linear models with a Poisson distribution, controlled for presence of other adulterants, expected drug, geographic location, and month.

Results: Between February 2022 and May 2024, 80,415 samples were analyzed at community sites. Among eligible samples, 36.1% were expected opioids, 42.2% of which were checked post-consumption. AE were noted among 10.7% of post-consumption opioid drug checks. After adjustment, the presence of benzodiazepines in opioid samples was associated with increased prevalence of any AE (aPR 1.97; 95% CI 1.70-2.27), as was the presence of xylazine (aPR 1.50; 95% CI 1.09-2.07). Considering specific AE, benzodiazepines were associated with increased prevalence of overdose (aPR 2.05; 95% CI 1.68-2.51) and prolonged sedation (aPR 3.35; 95% CI 2.54-4.43).

Conclusion: Non-fatal AE associated with unregulated opioids have been largely undescribed. Our findings report specific AE associated with different adulterants in the unregulated opioid supply. With this information, tailored public health interventions and services focused on these adulterants can be developed.

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来源期刊

Canadian Journal of Public Health-Revue Canadienne De Sante Publique PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.10

自引率

4.70%

发文量

128

期刊介绍： The Canadian Journal of Public Health is dedicated to fostering excellence in public health research, scholarship, policy and practice. The aim of the Journal is to advance public health research and practice in Canada and around the world, thus contributing to the improvement of the health of populations and the reduction of health inequalities. CJPH publishes original research and scholarly articles submitted in either English or French that are relevant to population and public health. CJPH is an independent, peer-reviewed journal owned by the Canadian Public Health Association and published by Springer. Énoncé de mission La Revue canadienne de santé publique se consacre à promouvoir l’excellence dans la recherche, les travaux d’érudition, les politiques et les pratiques de santé publique. Son but est de faire progresser la recherche et les pratiques de santé publique au Canada et dans le monde, contribuant ainsi à l’amélioration de la santé des populations et à la réduction des inégalités de santé. La RCSP publie des articles savants et des travaux inédits, soumis en anglais ou en français, qui sont d’intérêt pour la santé publique et des populations. La RCSP est une revue indépendante avec comité de lecture, propriété de l’Association canadienne de santé publique et publiée par Springer.