美国药物过量死亡人数在Covid-19大流行期间的记录

Overdose deaths in the United States have surged during the2019冠状病毒病大流行, primarily driven by increased fatalities from syntheticopioids并非法制造fentanyl, according to a疾病控制与预防中心（CDC）于2020年12月发布的报告.

Fatalities tied tosynthetic opioidsand illegalfentanylclimbed 38.4 percent in the 12 months ending in May 2020, compared with the same period ending in May 2019, according to the CDC. The spike in overdose deaths tied to these substances was even steeper in several parts of the country, almost doubling in 10 Western states.

此外，涉及心理刺激因素的过量死亡，例如甲基苯丙胺increased by 34.8 percent, exceeding the total number of fatalities involving cocaine. Overdose deaths from cocaine climbed 26.5 percent, likely due to combined use with illegally manufactured fentanyl or heroin, the CDC reports.

There are likely several reasons why drug overdose deaths have surged since the onset of the COVID-19 pandemic, saysAlana Vivolo-Kantor，博士, lead health scientist at the division of overdose prevention at the CDC in Atlanta. These include a larger supply of illegal drugs, reduced access to addiction and overdose treatment, and the lethality of synthetic fentanyl.

“Limited access to and disruption in treatment for patients who use drugs or with substance use disorder can be very stressful,” Dr. Vivolo-Kantor says. “There is a concern that these disruptions can lead to increased use or return to drug use for people not currently using.”

RELATED:Opioid Crisis Response Leaves Black Americans Behind

How the Pandemic Can Make Addiction Worse

Thebob app官方下载 creates a perfect storm to worsen substance use and addiction,says Austin Kilaru, MD, assistant professor of emergency medicine at the University of Pennsylvania in Philadelphia.

“The unprecedentedsocial isolation, coupled with unemployment and financial distress, are likely important factors increasing risks for patients,” says Dr. Kilaru, who wasn’t involved in the CDC report. “For patients with substance use disorders, overdoses that occur while alone are more likely to result in death.”

一个研究于2020年12月发表在城市健康杂志例如，发现在印第安纳波利斯（Indianapolis）的全职订单后，过量死亡人数激增了47％。在这个社区中，在全职订单后，对紧急医疗服务（EMS）的呼吁总体上升了4％，而EMS要求过量剂量增加43％。

阿片类药物的过量服用在失业者，独自生活或生活在贫困中的人们中也更为普遍 - 在大流行期间，所有情况都变得越来越普遍。一个study published in January 2020 inPLoS One, for example, found that people without jobs or spouses were more than twice as likely to die from opioid overdoses as those who were married and employed.

Kilaru说，涉及合成芬太尼的过量服药的数量越来越严重，因为这种物质使人们过量服用时更有可能死亡。滥用药物的人可能会在没有意识到这一点的情况下寻找芬太尼，使用比他们预期的更有效且可能具有致命剂量的芬太尼，或者服用他们不知道的阿片类药物或兴奋剂。

“Illicitly manufactured fentanyl is extremely lethal regardless if it’s used alone or mixed with other drugs,” says Vivolo-Kantor.

芬太尼使过量服用更危险的部分原因是Narcan (naloxone),一种药物that saves lives by inhibiting the breathing suppression caused by opioids, doesn’t work as well against fentanyl, Vivolo-Kantor says.

Vivolo-Kantor说：“这增加了即使人们得到迅速治疗，过量服药也会致命。”“我们也知道可能需要几剂纳洛酮to reverse its [fentanyl's] effects.”

RELATED:美国阿片类药物过量幸存者很少能及时治疗

Opioid Addiction Treatment During the Pandemic

Pandemic shutdowns that havereduced access to care对于许多健康问题，还限制了吸毒的治疗方法。尽管在大流行期间使用远程医疗访问，但这种护理仍有独特的障碍，这些障碍是为了帮助患有阿片类药物使用障碍的人的复杂努力。Stefan Kertesz，医学博士，伯明翰阿拉巴马大学和伯明翰退伍军人事务医疗中心。

Federal, state, and local governments have restrictions in place that limit who can prescribe medications for opioid use disorder, where patients can get these treatments, how much medicine patients can get at once, and what lab tests or clinic visits may be required for refills.

Some restrictions were loosened during the pandemic. The federalSubstance Abuse and Mental Health Services Administrationeased rules requiring daily clinic visits for the anti-addiction drugmethadone,而不是允许一些28天或14天supply at once. And the federalDrug Enforcement Administrationchanged prescription rules for the anti-addiction drugbuprenorphineto allow telehealth visits for doctors to prescribe the drug and permit refills without requiring patients to first get a drug test.

While changes like this have made it possible for some patients to access treatment who might have otherwise been cut off during the pandemic, many individuals with substance use disorder may still lack access to care because they don’t have internet, or a mobile phone or computer, to use telehealth services, says Dr. Kertesz.

Kertesz说：“许多严峻的海峡中的许多人都没有出色的数据计划和智能手机。”

一个t the onset of the pandemic, only about 1 in 4 substance use treatment facilities in the United States had the capacity to offer telehealth services, according to a研究于2020年12月发表在成瘾医学杂志.

Even within the Veterans Health Administration, through which telehealth services have long been an option for a wide variety of care, this option isn’t always accessed by vulnerable patients and individuals with substance use disorder, according to a separate研究于2020年12月发表在成瘾医学杂志. This study focused on veterans with a history of homelessness, and it found that, among those with various成瘾类型, use of a web-based portal for care was much lower among patients with opioid use disorder.

如何帮助患有阿片类药物使用障碍的人

如果您认识一个在大流行期间挣扎着成瘾的人，则应定期与他们进行检查并提议帮助他们获得治疗，就像您对其他患有糖尿病或心脏病等慢性健康问题的人一样，医学博士Bill Soares，医学博士马萨诸塞州斯普林菲尔德的Baystate医疗中心急诊医学系减少伤害服务。

“Realize that COVID-19 has increased stress and isolation for all of us, and that increases a person's likelihood of relapsing on drugs,” Dr. Soares says. “Check in with loved ones with opioid use disorder in a nonjudgmental, supportive way.”

如果可以的话，您应该提供帮助协调诊所的访问并接手阿片类药物使用障碍药物. In addition, you should carry naloxone and know how to use it in an emergency.

“Have naloxone available in multiple locations, such as your house, your car, and your purse, and encourage a person to never use drugs alone, and never in a place that they might not be found,” Soares says.