Ruscitto A, Smith B H, Guthrie B
Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland.
Eur J Pain. 2015 Jan;19(1):59-66. doi: 10.1002/ejp.520. Epub 2014 May 8.
Despite recent concerns about increasing rates of analgesic prescribing, detailed epidemiological studies are lacking. We identified and described changes in the pattern of community-dispensed prescriptions to the Tayside population, Scotland, between 31st March 1995 (n = 301,020) and 31st March 2010 (n = 311,881).
Repeated cross-sectional analysis of patient-level population data on dispensed analgesics, stratified by sociodemographic variables; logistic regression to identify factors associated with strong opioid dispensing in 2010.
The proportion of people currently dispensed any analgesic increased in 2010 (17.9%) compared with 1995 (15.7%). This increase was not equal across drug classes, with paracetamol, opioids and gabapentin/pregabalin showing an increase, but others showing a decrease. Weak opioids were less commonly dispensed in 2010 (8.2% vs. 8.4%) but dispensing of strong opioids increased 18-fold (3.6% vs. 0.2%), including a five-fold increase of morphine, fentanyl or oxycodone (0.75% vs. 0.15%). People receiving more non-analgesic drugs (odds ratio 20.7 if dispensed >14 non-analgesic medications vs. those dispensed <4) and those living in more deprived areas (OR 1.63 most deprived vs. most affluent) were more likely to receive a strong opioid in 2010.
Analgesic use rose modestly between 1995 and 2010, but with larger changes within individual classes, only partly reflecting evidence-based guidance. Dispensing of strong opioids increased dramatically, largely driven by tramadol, although other strong opioids tripled. Polypharmacy and socio-economic deprivation were strongly associated with strong opioid use. Research is needed to establish the causes, benefits and harms of the increase in analgesic, and especially strong opioid use.
尽管近期人们对镇痛药处方开具率上升有所担忧，但缺乏详细的流行病学研究。我们确定并描述了1995年3月31日（n = 301,020）至2010年3月31日（n = 311,881）期间苏格兰泰赛德地区社区配发处方模式的变化。
对配发镇痛药的患者层面人群数据进行重复横断面分析，按社会人口统计学变量分层；采用逻辑回归确定2010年与强阿片类药物配发相关的因素。
与1995年（15.7%）相比，2010年目前正在服用任何镇痛药的人群比例有所增加（17.9%）。各类药物的增加情况并不相同，对乙酰氨基酚、阿片类药物和加巴喷丁/普瑞巴林呈上升趋势，而其他药物则呈下降趋势。2010年弱阿片类药物的配发频率较低（8.2%对8.4%），但强阿片类药物的配发量增加了18倍（3.6%对0.2%），其中吗啡、芬太尼或羟考酮增加了5倍（0.75%对0.15%）。2010年，服用更多非镇痛药的人群（若配发>14种非镇痛药与配发<4种非镇痛药相比，比值比为20.7）以及生活在更贫困地区的人群（最贫困地区与最富裕地区相比，比值比为1.63）更有可能服用强阿片类药物。
1995年至2010年间镇痛药的使用略有上升，但各类药物内部变化较大，仅部分反映了循证指南。强阿片类药物的配发量大幅增加，主要由曲马多推动，尽管其他强阿片类药物也增加了两倍。多种药物联合使用和社会经济剥夺与强阿片类药物的使用密切相关。需要开展研究以确定镇痛药尤其是强阿片类药物使用增加的原因、益处和危害。
