Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
Pharmacy Department, Austin Health, Melbourne, Australia.
Br J Clin Pharmacol. 2018 Jun;84(6):1267-1278. doi: 10.1111/bcp.13556. Epub 2018 Apr 2.
To identify patterns of opioid analgesic use and determine predictors of persistent opioid use among people without cancer.
A population-based cohort study of Australians initiating prescription opioids from July 2013 to December 2015 was conducted using data from a random 10% sample of people who accessed medicines through Australia's Pharmaceutical Benefits Scheme. A 12-month retrospective period was used to define opioid initiation, exclude people with cancer and determine comorbidities. Persistent use over 12 months since initiation was identified through group-based trajectory modelling. Odds ratios (OR) and 95% confidence intervals (CIs) for predictors of opioid persistence were estimated using logistic regression.
The cohort consisted of 431 963 people without cancer who initiated opioids. A total of 11 323 (2.6%) persistent opioid users were identified. Predictors of persistence included initiation with transdermal formulations (OR 4.2, 95% CI 3.9-4.5), or initiation with total oral morphine equivalents (OME) ≥ 750 mg (3.7, 3.3-4.1), having depression (1.6, 1.5-1.7) or psychotic illness (2.0, 1.9-2.2). Previous dispensing of paracetamol (2.0, 1.9-2.1), pregabalin (2.0, 1.8-2.1) and benzodiazepines (1.53, 1.4-1.6) predicted persistence. Compared to people aged 18-44 years, those ≥75 years were 2.5 (2.3-2.6) times more likely to be persistent users.
Patient-specific characteristics (older age, prior history of mental health comorbidities and use of non-opioid analgesics) and prescriber choice of initial opioid (transdermal formulation and higher total OMEs) were found to strongly predict persistent use. This information may help prescribers target monitoring and early intervention efforts in order to prevent harms associated with the long-term use of opioids.
确定非癌症人群中阿片类镇痛药使用模式，并确定持续性使用阿片类药物的预测因素。
本研究采用澳大利亚药品福利计划随机抽取的 10%的人群数据，开展了一项基于人群的队列研究，该研究纳入了 2013 年 7 月至 2015 年 12 月期间开始处方阿片类药物的澳大利亚人群。使用 12 个月的回顾性时间段来定义阿片类药物的起始使用，排除癌症患者，并确定合并症。通过基于群组的轨迹建模确定起始使用后 12 个月内的持续性使用。使用逻辑回归估计持续性使用的预测因素的优势比（OR）和 95%置信区间（CI）。
该队列包括 431963 名无癌症的起始使用阿片类药物的人群。共确定了 11323 名（2.6%）持续性使用阿片类药物的患者。持续性使用的预测因素包括使用透皮制剂（OR 4.2，95%CI 3.9-4.5）或起始使用总口服吗啡等效剂量（OME）≥750mg（OR 3.7，3.3-4.1）、患有抑郁症（OR 1.6，1.5-1.7）或精神病（OR 2.0，1.9-2.2）。先前配给对乙酰氨基酚（OR 2.0，1.9-2.1）、普瑞巴林（OR 2.0，1.8-2.1）和苯二氮䓬类药物（OR 1.53，1.4-1.6）也预测了持续性使用。与 18-44 岁的人群相比，≥75 岁的人群持续性使用的可能性高 2.5 倍（2.3-2.6）。
发现患者的个体特征（年龄较大、先前存在精神健康合并症和使用非阿片类镇痛药）和初始阿片类药物的处方选择（透皮制剂和较高的总 OME）强烈预测了持续性使用。这些信息可能有助于医生针对监测和早期干预措施，以预防与长期使用阿片类药物相关的危害。
