Bedson John, Chen Ying, Hayward Richard A, Ashworth Julie, Walters Kate, Dunn Kate M, Jordan Kelvin P
Institute for Primary Care and Health Sciences, Staffordshire, United Kingdom.
Research Department of Primary Care and Population Health, UCL, London, United Kingdom.
Pain. 2016 Jul;157(7):1525-1531. doi: 10.1097/j.pain.0000000000000557.
Long-term opioids may benefit patients with chronic pain but have also been linked to harmful outcomes. In the United Kingdom, the predominant source of opioids is primary care prescription. The objective was to examine changes in the incidence, length, and opioid potency of long-term prescribing episodes for musculoskeletal conditions in UK primary care (2002-2013). This was an observational database study (Clinical Practice Research Datalink, 190 practices). Participants (≥18 years) were prescribed an opioid for a musculoskeletal condition (no opioid prescribed in previous 6 months), and issued ≥2 opioid prescriptions within 90 days (long-term episode). Opioids were divided into short- and long-acting noncontrolled and controlled drugs. Annual incidence of long-term opioid episodes was determined, and for those still in a long-term episode, the percentage of patients prescribed each type 1 to 2 years, and >2 years after initiation. Annual denominator population varied from 1.25 to 1.38 m. A total of 76,416 patients started 1 long-term episode. Annual long-term episode incidence increased (2002-2009) by 38% (42.4-58.3 per 10,000 person-years), remaining stable to 2011, then decreasing slightly to 55.8/10,000 (2013). Patients prescribed long-acting controlled opioids within the first 90 days of long-term use increased from 2002 to 2013 (2.3%-9.9%). In those still in a long-term opioid episode (>2 years), long-acting controlled opioid prescribing increased from 3.5% to 22.6%. This study has uniquely shown an increase in prescribing long-term opioids to 2009, gradually decreasing from 2011 in the United Kingdom. The trend was towards increased prescribing of controlled long-acting opioids and earlier use. Further research into the risks and benefits of opioids is required.
长期使用阿片类药物可能对慢性疼痛患者有益，但也与不良后果有关。在英国，阿片类药物的主要来源是初级保健处方。目的是研究英国初级保健中（2002 - 2013年）肌肉骨骼疾病长期处方事件的发生率、时长和阿片类药物效力的变化。这是一项观察性数据库研究（临床实践研究数据链，190家诊所）。参与者（≥18岁）因肌肉骨骼疾病被开具阿片类药物处方（过去6个月内未开具阿片类药物），且在90天内开具≥2张阿片类药物处方（长期事件）。阿片类药物分为短效和长效非管制及管制药物。确定长期阿片类药物事件的年发生率，对于仍处于长期事件中的患者，确定开始使用后1至2年以及>2年后开具每种类型药物的患者百分比。每年的分母人群从125万到138万不等。共有76416名患者开始了1次长期事件。长期事件的年发生率在2002 - 2009年增加了38%（每10000人年从42.4增加到58.3），到2011年保持稳定，然后略有下降至55.8/10000（2013年）。在长期使用的前90天内开具长效管制阿片类药物的患者从2002年到2013年有所增加（从2.3%增至9.9%）。在仍处于长期阿片类药物事件（>2年）的患者中，长效管制阿片类药物的处方从3.5%增至22.6%。这项研究独特地表明，在英国，长期阿片类药物的处方量在2009年之前增加，从2011年开始逐渐减少。趋势是长效管制阿片类药物的处方增加且使用更早。需要对阿片类药物的风险和益处进行进一步研究。
