AIMS To examine trends and recent changes in non-fatal and fatal stimulant overdose rates with and without opioids to improve the descriptive characterization of the US overdose epidemic. DESIGN Secondary analysis of non-fatal (2006-16) and fatal (2006-17) drug overdose trends, focusing on the most recent years of data available to examine rate changes by demographics (2015-16 for non-fatal and 2016-17 for fatal). SETTING Non-fatal drug overdoses from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample; drug overdose deaths from the National Vital Statistics System. PARTICIPANTS/CASES International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) codes for cocaine, psychostimulants and opioids were used to classify non-fatal drug overdoses. Drug overdose deaths were identified using ICD-10 multiple cause-of-death codes for cocaine, psychostimulants, all opioids, heroin and synthetic opioids. MEASUREMENTS Percentage of changes in age-adjusted non-fatal and fatal rates of cocaine and psychostimulant-involved drug overdose with and without opioids. FINDINGS Overall, cocaine-involved non-fatal overdose rates with an opioid increased from 2006 to 2016 [annual percentage change (APC) = 14.7], while rates without an opioid increased from 2006 to 2012 (APC = 11.3) and then remained stable (APC = -7.5). Psychostimulant-involved non-fatal rates with and without an opioid increased from 2006 to 2016 (APC = 49.9 with opioids; 13.9 without opioids). Cocaine-involved death rates with and without opioids increased from 2014 to 2017 (APC = 46.0 with opioids, 23.6 without opioids). Psychostimulant-involved death rates with opioids increased from 2010 to 2015 (APC = 28.6), with a dramatic increase from 2015 to 2017 (APC = 50.5), while rates without opioids increased from 2008 to 2017 (APC = 22.6). In 2016, 27% of non-fatal cocaine- and 14% of psychostimulant-involved overdoses included a reported opioid; 72.7% of cocaine- and 50.3% of psychostimulant-involved deaths involved an opioid in 2017. From 2015 to 2016, cocaine-involved and psychostimulant-involved non-fatal overdose rates with an opioid increased 17.0 and 5.9%, respectively; cocaine-involved and psychostimulant-involved non-fatal overdoses without opioids decreased 13.6 and increased 18.9%, respectively. Death rates involving stimulants increased with and without opioids from 2016 to 2017 (cocaine with and without opioids = 37.7 and 23.3%; psychostimulants with and without opioids = 52.2 and 23.0%). Death rates involving stimulants with synthetic opioids increased dramatically from 2016 to 2017 (1.3-2.3 per 100 000 for cocaine and 0.3-0.8 for psychostimulants). CONCLUSIONS While increases in cocaine-involved deaths in the United States from 2006 seem to be driven by opioids, particularly synthetic opioids, increases in non-fatal and fatal overdoses involving psychostimulants are occurring with and without opioids.

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在美国，涉及含或不含阿片类药物的兴奋剂的非致命和致命过量用药有所增加


目的 研究使用和不使用阿片类药物的非致命和致命兴奋剂过量率的趋势和近期变化，以改善美国药物过量流行病的描述性特征。设计 对非致命性（2006-16 年）和致命性（2006-17 年）药物过量趋势进行二次分析，重点关注最近几年可用于检查人口统计比率变化的数据（2015-16 年为非致命性药物过量，2016-17 年为非致命性药物过量）对于致命的）。从医疗保健成本和利用项目的全国急诊科样本中确定非致命药物过量；国家人口动态统计系统中的药物过量死亡。参与者/病例 使用可卡因、精神兴奋剂和阿片类药物的国际疾病分类第九版临床修改 (ICD-9-CM) 和第十版临床修改/程序编码系统 (ICD-10-CM/PCS) 代码进行分类非致命药物过量。使用可卡因、精神兴奋剂、所有阿片类药物、海洛因和合成阿片类药物的 ICD-10 多重死因代码来确定药物过量死亡。测量 服用和不服用阿片类药物的可卡因和精神兴奋剂药物过量的年龄调整非致命和致命率的变化百分比。结果 总体而言，从 2006 年到 2016 年，使用阿片类药物的可卡因非致命性过量用药率有所上升 [年度百分比变化 (APC) = 14.7]，而没有使用阿片类药物的比例从 2006 年到 2012 年有所增加 (APC = 11.3)，然后保持稳定（ APC = -7.5）。从 2006 年到 2016 年，使用和不使用阿片类药物的精神兴奋剂相关非死亡率有所增加（使用阿片类药物时 APC = 49.9；不使用阿片类药物时 APC = 13.9）。从 2014 年到 2017 年，使用和不使用阿片类药物的可卡因相关死亡率均有所增加（使用阿片类药物的 APC = 46.0，不使用阿片类药物的 APC = 23.6）。 从 2010 年到 2015 年，使用阿片类药物的精神兴奋剂相关死亡率有所上升（APC = 28.6），从 2015 年到 2017 年急剧增加（APC = 50.5），而没有使用阿片类药物的死亡率从 2008 年到 2017 年有所增加（APC = 22.6）。 2016 年，27% 的非致命性可卡因过量服用和 14% 的精神兴奋剂过量服用均含有阿片类药物； 2017 年，72.7% 的可卡因死亡和 50.3% 的精神兴奋剂相关死亡与阿片类药物有关。从 2015 年到 2016 年，可卡因和精神兴奋剂相关的阿片类药物非致命过量用药率分别增加了 17.0% 和 5.9%；不含阿片类药物的可卡因和精神兴奋剂非致命过量用药分别减少 13.6% 和增加 18.9%。 2016 年至 2017 年，使用和不使用阿片类药物的兴奋剂死亡率均有所增加（含和不含阿片类药物的可卡因 = 37.7% 和 23.3%；含和不含阿片类药物的精神兴奋剂 = 52.2% 和 23.0%）。 2016 年至 2017 年，涉及合成阿片类兴奋剂的死亡率急剧上升（可卡因为每 10 万人 1.3-2.3 人，精神兴奋剂为每 10 万人 0.​​3-0.8 人）。结论 虽然自 2006 年以来美国可卡因相关死亡人数的增加似乎是由阿片类药物（尤其是合成阿片类药物）驱动的，但无论是否使用阿片类药物，涉及精神兴奋剂的非致命和致命过量用药都在增加。