背景:注入,吸烟,吸食海洛因/合成阿片类药物都有独特的健康风险。目前尚不清楚在阿片类药物流行期间,给药途径(ROA)偏好是如何转变的。
方法:使用SAMHSATEDS-A的2000-2021年入院数据,我们分析了海洛因/合成阿片类药物ROA偏好的趋势以及与这些偏好相关的因素.
结果:7,881,318海洛因/合成阿片类药物入院报告注射,吸烟,或吸食偏好。在全国范围内,注射在2014年达到峰值(69.9%),在2021年达到最低点(52.2%),吸食率在2014年下降(24.9%),2021年达到峰值(36.4%),吸烟率从2005年的2.5%稳步上升至2021年的11.4%的峰值。从2000年到2021年,吸烟率≥10%的州数量从2个增加到27个(最高:2021年亚利桑那州为57.0%)。在2021年,非注射使用与注射使用的调整后患病率(APR)增加与首次使用阿片类药物的年龄增加有关(APR1.52[95%CI:1.51,1.54],相对于≤20),以及相对于非拉丁裔白人的所有种族/族裔(最高:黑人,APR1.77[1.75,1.78])。地理强烈预测吸烟与吸食(山区APR6.91[6.64,7.19],太平洋APR6.61[6.35,6.88],参考:新英格兰)。
结论:自2000年以来,海洛因/合成阿片类药物的ROA偏好发生了实质性变化,其中:1)最近全国注射量减少;2)吸烟增加,特别是在美国西部;3)美国东部最近增加的打鼾。吸烟现在很普遍,而且越来越多。公共卫生影响包括越来越多的与吸烟相关的致命过量和注射特异性发病率的可能降低和吸烟特异性发病率的增加。
BACKGROUND: Injecting, smoking, and snorting heroin/synthetic opioids is each associated with unique health risks. It is unclear how route of administration (ROA) preferences have shifted during the opioid epidemic.
METHODS: Using 2000-2021 admissions data from SAMHSA TEDS-A, we analyzed trends in heroin/synthetic opioid ROA preferences and factors associated with these preferences.
RESULTS: 7,881,318 heroin/synthetic opioid admissions reported injection, smoking, or snorting preference. Nationally, injection peaked in 2014 (69.9 %) and nadired in 2021(52.2 %), snorting nadired in 2014 (24.9 %) and peaked in 2021 (36.4 %), and smoking rose steadily from 2.5 % in 2005 to a peak of 11.4 % in 2021. From 2000-2021, the number of states with ≥10 % smoking rates grew from 2 to 27 (highest: 57.0 % in Arizona in 2021). In 2021, increased adjusted prevalence ratios (APR) of non-injection versus injection use were associated with older age at first opioid use (APR 1.52 [95 % CI: 1.51, 1.54] for those 30+ relative to ≤20), and all race/ethnicities relative to non-Latino White individuals (highest: Black individuals, APR 1.77 [1.75, 1.78]). Geography strongly predicted smoking versus snorting (Mountain APR 6.91 [6.64, 7.19], Pacific APR 6.61 [6.35, 6.88], reference: New England).
CONCLUSIONS: ROA preferences of heroin/synthetic opioids have changed substantially since 2000, with: 1) recent decreases in injection nationally; 2) increased smoking, particularly in the western US; and, 3) recent increased snorting in the eastern US. Smoking is now prevalent and growing. Public health implications include an increasing number of smoking-related fatal overdoses and the probable reduction of injection-specific morbidity and increase in smoking-specific morbidity.