Backgrounds: Between 2009 and 2018, the number of opioid-related deaths (ORDs) in Scotland showed a dramatic increase, whereas in England and Wales, a much lower increase in ORD was seen. This regional difference is remarkable, and the situation in Scotland is worrisome. Therefore, it is important to identify the drivers of ORD in Scotland. Methods: A systematic literature review according to PRISMA guidelines was conducted to identify peer-reviewed studies about key drivers for the observed differences in ORDs between Scotland and England/Wales. In addition, non-peer-reviewed reports on nationwide statistical data were retrieved via Google and Google Scholar and analysed to quantify differences in ORD drivers between Scotland and England/Wales. Results: The systematic review identified some important drivers of ORD, but none of these studies provided direct or indirect comparisons of ORD drivers in Scotland and England/Wales. However, the reports with nationwide statistical data showed important differences in ORD drivers between Scotland and England/Wales, including a higher prevalence of people using opioids in a problematic way (PUOP), more polydrug use in people using drugs in a problematic way (PUDP), a higher age of PUDP, and lower treatment coverage and efficacy of PUDP in Scotland compared to England/Wales, but no regional differences in injecting drug use, incarceration/prison release without treatment, and social deprivation in PUDP. Conclusion: It is concluded that the opioid crisis in Scotland is best explained by a combination of drivers, consisting of a higher population involvement in (problematic) opioid use (notably methadone), relatively more polydrug use (notably benzodiazepines and gabapentinoids), a steeper ageing of the PUOP population in the past 2 decades, and lower treatment coverage and efficacy in Scotland compared to England/Wales. The findings have important consequences for strategies to handle the opioid crisis in Scotland.
Eur Addict Res

中文翻译：

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解释苏格兰和英格兰/威尔士之间阿片类药物过量死亡的差异：对欧洲阿片类药物政策的影响

背景： 2009年至2018年间，苏格兰与阿片类药物相关的死亡（ORD）数量急剧增加，而在英格兰和威尔士，ORD的增幅则要低得多。这种地区差异显着，苏格兰的情况令人担忧。因此，确定苏格兰 ORD 的驱动因素非常重要。方法：根据 PRISMA 指南进行系统文献综述，以确定苏格兰和英格兰/威尔士之间观察到的 ORD 差异的关键驱动因素的同行评审研究。此外，通过 Google 和 Google Scholar 检索了未经同行评审的全国统计数据报告，并进行了分析，以量化苏格兰和英格兰/威尔士之间 ORD 司机的差异。结果：系统评价确定了 ORD 的一些重要驱动因素，但这些研究都没有提供苏格兰和英格兰/威尔士 ORD 驱动因素的直接或间接比较。然而，包含全国统计数据的报告显示苏格兰和英格兰/威尔士之间 ORD 驱动因素存在显着差异，包括以有问题的方式使用阿片类药物的人 (PUOP) 的患病率较高，以有问题的方式使用药物的人使用多种药物的比例更高 (PUDP) ），与英格兰/威尔士相比，苏格兰的 PUDP 年龄较高，PUDP 的治疗覆盖率和疗效较低，但 PUDP 在注射吸毒、未经治疗的监禁/出狱以及社会剥夺方面没有地区差异。结论：得出的结论是，苏格兰的阿片类药物危机最好由多种驱动因素来解释，包括较高的人口参与（有问题的）阿片类药物（特别是美沙酮）的使用、相对更多的多种药物的使用（特别是苯二氮卓类药物和加巴喷丁类药物）、更陡峭的阿片类药物使用。过去 20 年来，PUOP 人口老龄化，与英格兰/威尔士相比，苏格兰的治疗覆盖率和疗效较低。这些发现对苏格兰处理阿片类药物危机的策略产生了重要影响。
欧洲成瘾者研究中心