Addiction, Journal Year: 2024, Volume and Issue: unknown
Published: Dec. 17, 2024
High and variable opioid potency has a disproportionate dynamic impact on overdose risk, limiting the risk that can be modified with prevention strategies. A mere 30 years ago, was considered an inevitable consequence of use. People who use drugs, service providers investigators leveraged lived experience research findings to serve lie this fatalistic misconception create field is now major component how many countries respond substance Naloxone provision, medications for disorder (MOUD) safe consumption spaces are prototypical interventions in domain. However, our ability measure impacts these remains nascent. Stam et al. [1] provide significant contribution evolution by examining rates day at supervised injecting facility. There multiple contributors mortality rates. Using Norman Zinberg's construct drug, set setting, we identify diverse potential factors (Figure 1) [2]. Addressing reverse order, 'setting' refers environment within which occurs. The illegal status street opioids creates unregulated market notoriously unstable, stigmatized [3], under constant pressure from law enforcement [4] associated other socio-economic pressures such as poverty, housing crises structural racism. Issues simple using unfamiliar place may lower one's tolerance drug [5], improve environmental include better access naloxone, MOUD [6]. 'Set', or internal conditions, most often thought [7]. Recent abstinence long been maintaining among effective interventions. Data anesthesiology also demonstrate clear genetic [8], co-morbid health conditions cardiovascular pulmonary disease contribute some amount [9]. Suicidality, spectrum behavior negligence planned self-harm, factor latter contributing approximately 15% 20% events [10]. Mental disorders personal trauma 'Drug' polypharmacy, sedating substances raising negating protection [11]. Route administration relevant, heroin 4-fold higher rate than sniffing smoking [12], leading harm reduction programs encourage transitions smoking. Although transition appears less protective people fentanyl, emerging data suggest when fentanyl exclusively smoked instead injected [13]. Supervised injection sites have previously established twice risky prescription regard four times [14]. Moreover, Darke [15] ago determined both variations were moderately risk. al.'s actual much greater, up 10-fold difference days more overdosing, presumably representing either potent undergoing substantial variation potency. No documented influence Most notably, however, estimate comes region without sold street. Throughout North America, consistently increased 4- 5-fold replaced dominant [16]. Models effectiveness naloxone reducing highly sensitive prevalence use; programming reaches nearly all would expected reduce 26% 12%, respectively Given universal increase wherever replace opioids, weakened response evidence-based likely extends MOUD, variability so extreme, relative heroin, it overwhelm factors, leaving room extant meaningful impact. Our predict patterns limited. remind us power over tragic outcome importance not promising public deliver. proportional static, but dynamic, depending available opioids. Additional new era mathematical modeling needed None. sharing applicable article no created analyzed study.
Language: Английский
