This cross-sectional analysis aimed to understand the similarities and differences between drugs detected in syringes collected from syringe service providers in the District of Columbia and fatal overdose deaths captured by the State Unintentional Drug Overdose Reporting System. Substance exposures for these fatal and non-fatal drug use outcomes have not been previously compared. Substance distributions were examined and a paired significance test was used to compare changes over time. Affinity analysis was employed to reveal substance co-occurrences. Between September, 2020-2022, 1,118 post-mortem blood samples and 3,646 syringes were processed, with fatal overdoses increasing 24.1%. Polysubstance use was more commonly found in post-mortem blood (82.5%) than syringe exchange samples (48.6%). Of samples containing opioids, 94.8% of blood samples and 86.3% of syringes contained fentanyl, fentanyl analogs, or fentanyl precursors/metabolites. Post-mortem blood samples had double the frequency of co-occurring stimulants and opioids (43.9%) as syringe exchange samples (21.8%). Major changes in occurrence frequency over time were found for opioid and stimulant exposure in both groups, especially in the increased occurrence of fluorofentanyl (>400%), methamphetamine (>90%), and xylazine (>60%) while the incidence of fentanyl, heroin, and metabolite morphine declined. These results indicate that while fatal use and syringe exchange populations have distinct substance exposures which may contribute to differences in mortality rate, their substance distributions have similar change magnitudes. This study highlights the utility of using multiple data sources to provide a comprehensive description of drug use patterns and discusses the limitations in reporting data from each source.

中文翻译：

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哥伦比亚特区注射器交换和死后血液样本的比较毒理学：趋势和亲和力分析

这项横断面分析旨在了解从哥伦比亚特区注射器服务提供商收集的注射器中检测到的药物与州无意药物过量报告系统捕获的致命过量死亡之间的异同。此前尚未对这些致命和非致命药物使用结果的物质暴露进行比较。检查了物质分布，并使用配对显着性检验来比较随时间的变化。采用亲和力分析来揭示物质共现。2020 年 9 月至 2022 年期间，处理了 1,118 份尸检血液样本和 3,646 个注射器，致命过量用药增加了 24.1%。尸检血液中多物质的使用（82.5%）比注射器交换样本（48.6%）更常见。在含有阿片类药物的样本中，94.8% 的血液样本和 86.3% 的注射器含有芬太尼、芬太尼类似物或芬太尼前体/代谢物。尸检血液样本中同时出现兴奋剂和阿片类药物的频率 (43.9%) 是注射器交换样本 (21.8%) 的两倍。两组中阿片类药物和兴奋剂暴露的发生频率随着时间的推移发生了重大变化，特别是氟芬太尼（>400%）、甲基苯丙胺（>90%）和赛拉嗪（>60%）的发生率增加，而阿片类药物和兴奋剂暴露的发生频率增加。芬太尼、海洛因和代谢物吗啡的发生率有所下降。这些结果表明，虽然致命使用和注射器交换人群具有不同的物质暴露情况，这可能导致死亡率差异，但他们的物质分布具有相似的变化幅度。本研究强调了使用多个数据源来提供药物使用模式的全面描述的效用，并讨论了报告每个来源数据的局限性。