An Assessment of Opioid Overdoses in San Francisco from 2010 through 2012

对 2010 年至 2012 年旧金山阿片类药物过量的评估

• 批准号: 8764664
• 负责人: PHILLIP O COFFIN
• 金额: $ 5.49万
• 依托单位: PUBLIC HEALTH FOUNDATION ENTERPRISES
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8764664
• 关键词: Address; Adult; Affect; Agonist; Alcohol or Other Drugs use; Antidotes; Behavioral; California; Censuses; Cessation of life; Characteristics; Cities; Client; Clinical; Clinical Data; Collaborations; Comorbidity; County; Crime; Data; Data Set; Data Sources; Databases; Death Rate; Development; Drug Monitoring; Drug usage; Education Projects; Effectiveness of Interventions; Electronics; Funding; Future; Goals; HIV; Healthcare; Healthcare Systems; Heroin; Housing; Improve Access; Incidence; Income; Income Distributions; Injury; Intervention; Life; Maintenance; Medical; Medical Examiners; Medical Records; Methods; Modeling; Monitor; Morbidity - disease rate; Naloxone; Narcotic Antagonists; Neighborhoods; Opioid; Opioid Analgesics; Outcome; Overdose; Patient Care; Persons; Pharmaceutical Preparations; Poisoning; Police; Population; Population Characteristics; Prevention education; Primary Health Care; Public Health; Records; Reporting; Research; Risk; San Francisco; Services; Source; Spatial Distribution; System; Toxicology; United States; United States Public Health Service; Vital Statistics; Woman; administrative database; cohort; demographics; economic cost; heroin overdose; high risk; men; methadone maintenance; mortality; novel; overdose death; overdose prevention; prescription opioid; programs; public health relevance; safety net; trend

DESCRIPTION (provided by applicant): Drug poisoning is now the leading cause of accidental death among adults in the U.S. and opioid analgesic overdose deaths dramatically increased by over 400% and 265% among women and men, respectively, from 1999-2010. The economic cost of opioid-related poisoning was estimated at $20.4 billion in the United States for 2009. Addressing opioid overdose is consistent with the White House goal of reducing drug-induced morbidity and mortality by 15%. San Francisco, historically a leading city for opioid use and related morbidity, witnessed a dramatic decline in heroin-related mortality after improving access to agonist maintenance services and implementing city-wide distribution of naloxone (the short-acting opioid antagonist used to reverse opioid overdose). However, a surge in opioid analgesic mortality negated much of this mortality benefit. We still understand little about "who" dies from opioid analgesics since there is no local system for monitoring opioid overdose indicators. Moreover, it is unclear how agonist maintenance services and naloxone distribution correlate with geographic concentration of opioid overdose deaths. To effectively respond to opioid overdose, it is critical to develop methods to identify and monitor overdose trends and evaluate the effectiveness of interventions. We propose a secondary analysis of opioid overdose decedent data collected from the California State Electronic Death Reporting System (EDRS) matched with data from the public substance use treatment record database and chart review of all patients cared for in the safety net healthcare system affiliated with the San Francisco Department of Public Health. We will evaluate annuals trends in opioid overdose deaths for San Francisco, overall and by neighborhood using Poisson regression models form 2010-2012 (aim 1). We will also describe the demographic and clinical characteristics of opioid overdose decedents in San Francisco County using toxicology and medical and substance use treatment records (aim 2). W explores the spatial overlap between opioid overdose decedents, lay naloxone distribution and lay naloxone use (aim 3). In exploratory aims, we will calculate the rate of opioid overdose mortality using US census, National HIV Behavioral Surveillance, and prescription drug monitoring program data for denominators, and conduct ecological analyses to look at the relationship between opioid overdose deaths and neighborhood-level factors. Findings from this study will inform the development of a local surveillance system to track opioid-related outcomes, strengthen the capacity to monitor opioid overdose mortality and enhance interventions to reduce opioid overdose mortality.

描述（由申请人提供）：目前，美国成年人意外死亡的主要原因，阿片类镇痛药过量死亡的死亡人数急剧增加了400％以上，男性和男性分别从1999年至2010年中分别增加了265％。 2009年，美国的阿片类药物相关中毒的经济成本估计为204亿美元。解决阿片类药物的过量剂与白宫的目标是将毒品引起的发病率和死亡率降低15％的目标一致。从历史上看，旧金山是阿片类药物使用及相关发病率的主要城市，在改善了对纳洛酮（用于反向阿片类药物过量的短暂作用的阿片类拮抗剂）（用于反向阿片类药物的短期拮抗剂）的访问之后，见证了与海洛因相关的死亡率的急剧下降）。但是，阿片类镇痛死亡率激增否定了这种死亡率的大部分。我们仍然对“谁”死于阿片类镇痛药，因为没有用于监视阿片类药物过量指标的局部系统。此外，尚不清楚激动剂维持服务和纳洛酮分布与阿片类药物过量死亡的地理浓度如何相关。为了有效地应对阿片类药物过量，至关重要的是开发方法来识别和监测过量趋势并评估干预措施的有效性。我们提出了对从加利福尼亚州电子死亡报告系统（EDRS）收集的阿片类药物过量死亡数据的次要分析，该数据与来自公共药物使用治疗记录数据库的数据匹配，并对与旧金山公共卫生部相关的所有安全网络医疗保健系统中关心的患者进行了图表审查。我们将使用Poisson回归模型表格2010- 2012年（AIM 1）评估旧金山的阿片类药物过量死亡的年度趋势。我们还将使用毒理学以及医学和药物使用治疗记录来描述旧金山县阿片类药物过量死者的人口统计和临床特征（AIM 2）。 W探讨了阿片类药物过量死者，纳洛酮分布和躺纳洛酮的使用之间的空间重叠（AIM 3）。在探索性目的中，我们将使用美国人口普查，全国HIV行为监测和处方药物监测计划数据来计算阿片类药物过量死亡率的速度，并进行生态分析以查看阿片类药物过量的死亡人数与邻里级别的因素之间的关系。这项研究的发现将为您的当地监视系统的发展提供信息，以跟踪阿片类药物相关的结果，增强监测阿片类药物过量死亡率的能力，并增强干预措施以降低阿片类药物过量死亡率。