Sociodemographic factors and social determinants associated with toxicology confirmed polysubstance opioid-related deaths.
Adolescent
Adult
Analgesics, Opioid
/ administration & dosage
Central Nervous System Stimulants
/ administration & dosage
Child
Drug Overdose
/ diagnosis
Female
Humans
Male
Massachusetts
/ epidemiology
Middle Aged
Opioid-Related Disorders
/ diagnosis
Social Determinants of Health
/ trends
Socioeconomic Factors
Young Adult
Amphetamines
Cocaine
Opioid-related overdose
Polysubstance use
Stimulants
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 07 2019
01 07 2019
Historique:
received:
02
01
2019
revised:
12
03
2019
accepted:
14
03
2019
pubmed:
18
5
2019
medline:
21
1
2020
entrez:
18
5
2019
Statut:
ppublish
Résumé
While prescribed and illicit opioid use are primary drivers of the national surges in overdose deaths, opioid overdose deaths in which stimulants are also present are increasing in the U.S. We determined the social determinants and sociodemographic factors associated with opioid-only versus polysubstance opioid overdose deaths in Massachusetts. Particular attention was focused on the role of stimulants in opioid overdose deaths. We analyzed all opioid-related overdose deaths from 2014 to 2015 in an individually-linked population database in Massachusetts. We used linked postmortem toxicology data to identify drugs present at the time of death. We constructed a multinomial logistic regression model to identify factors associated with three mutually exclusive overdose death groups based on toxicological results: opioid-related deaths with (1) opioids only present, (2) opioids and other substances not including stimulants, and (3) opioids and stimulants with or without other substances. Between 2014 and 2015, there were 2,244 opioid-related overdose deaths in Massachusetts that had accompanying toxicology results. Toxicology reports indicated that 17% had opioids only, 36% had opioids plus stimulants, and 46% had opioids plus another non-stimulant substance. Persons older than 24 years, non-rural residents, those with comorbid mental illness, non-Hispanic black residents, and persons with recent homelessness were more likely than their counterparts to die with opioids and stimulants than opioids alone. Polysubstance opioid overdose is increasingly common in the US. Addressing modifiable social determinants of health, including barriers to mental health services and homelessness, is important to reduce polysubstance use and overdose deaths.
Sections du résumé
BACKGROUND AND AIMS
While prescribed and illicit opioid use are primary drivers of the national surges in overdose deaths, opioid overdose deaths in which stimulants are also present are increasing in the U.S. We determined the social determinants and sociodemographic factors associated with opioid-only versus polysubstance opioid overdose deaths in Massachusetts. Particular attention was focused on the role of stimulants in opioid overdose deaths.
METHODS
We analyzed all opioid-related overdose deaths from 2014 to 2015 in an individually-linked population database in Massachusetts. We used linked postmortem toxicology data to identify drugs present at the time of death. We constructed a multinomial logistic regression model to identify factors associated with three mutually exclusive overdose death groups based on toxicological results: opioid-related deaths with (1) opioids only present, (2) opioids and other substances not including stimulants, and (3) opioids and stimulants with or without other substances.
RESULTS
Between 2014 and 2015, there were 2,244 opioid-related overdose deaths in Massachusetts that had accompanying toxicology results. Toxicology reports indicated that 17% had opioids only, 36% had opioids plus stimulants, and 46% had opioids plus another non-stimulant substance. Persons older than 24 years, non-rural residents, those with comorbid mental illness, non-Hispanic black residents, and persons with recent homelessness were more likely than their counterparts to die with opioids and stimulants than opioids alone.
CONCLUSIONS
Polysubstance opioid overdose is increasingly common in the US. Addressing modifiable social determinants of health, including barriers to mental health services and homelessness, is important to reduce polysubstance use and overdose deaths.
Identifiants
pubmed: 31100636
pii: S0376-8716(19)30146-2
doi: 10.1016/j.drugalcdep.2019.03.014
pmc: PMC6588486
mid: NIHMS1031610
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Central Nervous System Stimulants
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
59-63Subventions
Organisme : NIDA NIH HHS
ID : T32 DA013911
Pays : United States
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : NIGMS NIH HHS
ID : P20 GM125507
Pays : United States
Organisme : NIDA NIH HHS
ID : K23 DA042168
Pays : United States
Organisme : NIDA NIH HHS
ID : R25 DA037190
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI042853
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
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