Karanges Emily A, Buckley Nicholas A, Brett Jonathan, Blanch Bianca, Litchfield Melisa, Degenhardt Louisa, Pearson Sallie-Anne
Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Kensington, Australia.
Discipline of Pharmacology, School of Medical Sciences, University of Sydney, Sydney, Australia.
Pharmacoepidemiol Drug Saf. 2018 May;27(5):504-512. doi: 10.1002/pds.4369. Epub 2017 Dec 27.
Population-based observational studies have documented global increases in opioid analgesic use. Many studies have used a single population-adjusted metric (number of dispensings, defined daily doses [DDDs], or oral morphine equivalents [OMEs]). We combine these volume-based metrics with a measure of the number of persons dispensed opioids to gain insights into Australian trends in prescribed opioid use.
We obtained records of prescribed opioid dispensings (2006-2015) subsidised under Australia's Pharmaceutical Benefits Scheme. We used dispensing claims to quantify annual changes in use according to 3 volume-based metrics: DDD/1000 pop/day, OME/1000 pop/day, and dispensings/1000 pop. We estimated the number of persons dispensed at least one opioid in a given year (persons)/1000 pop using data from a 10% random sample of Pharmaceutical Benefits Scheme-eligible Australians.
Total opioid use increased according to all metrics, especially OME/1000 pop/day (51% increase) and dispensings/1000 pop (44%). Weaker opioid use remained stable or declined; strong opioid use increased. The rate of persons accessing weaker opioids only decreased 31%, and there was a 238% increase in persons dispensed only strong opioids. Strong opioid use also increased according to dispensings/1000 pop (140%), OME/1000 pop/day (80%), and DDD/1000 pop/day (71% increase).
Our results suggest that the increases in total opioid use between 2006 and 2015 were predominantly driven by a growing number of people treated with strong opioids at lower medicine strengths/doses. This method can be used with or without person-level data to provide insights into factors driving changes in medicine use over time.
基于人群的观察性研究记录了全球阿片类镇痛药使用量的增加。许多研究使用了单一的人群调整指标（配药量、限定日剂量[DDD]或口服吗啡当量[OME]）。我们将这些基于用量的指标与接受阿片类药物配药的人数相结合，以深入了解澳大利亚处方阿片类药物使用的趋势。
我们获取了澳大利亚药品福利计划补贴的阿片类药物处方配药记录（2006 - 2015年）。我们利用配药报销数据，根据3个基于用量的指标量化每年的使用变化：DDD/1000人/天、OME/1000人/天和配药量/1000人。我们使用符合药品福利计划资格的澳大利亚人的10%随机样本数据，估计给定年份中至少接受一次阿片类药物配药的人数（人数）/1000人。
根据所有指标，阿片类药物的总使用量均有所增加，尤其是OME/1000人/天（增加51%）和配药量/1000人（增加44%）。弱阿片类药物的使用保持稳定或下降；强阿片类药物的使用增加。仅使用弱阿片类药物的人数比例仅下降了31%，而仅接受强阿片类药物配药的人数增加了238%。根据配药量/1000人（增加140%）、OME/1000人/天（增加80%）和DDD/1000人/天（增加71%），强阿片类药物的使用也有所增加。
我们的结果表明，2006年至2015年阿片类药物总使用量的增加主要是由越来越多的人使用低强度/低剂量的强阿片类药物治疗所致。这种方法可用于有或没有个人层面数据的情况，以深入了解随时间推移推动药物使用变化的因素。
