Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia.
Pharmacy Department, Austin Health, Melbourne, VIC, Australia.
Br J Clin Pharmacol. 2019 Jan;85(1):202-215. doi: 10.1111/bcp.13792. Epub 2018 Nov 16.
The aims of the current study were to determine the prevalence and incidence of prescription opioid analgesic use in Australia and compare the characteristics of people with and without cancer initiating prescription opioid analgesics.
A retrospective population-based study was conducted using the random 10% sample of adults who were dispensed prescription opioid analgesics in Australia between July 2013 and June 2017 through the Pharmaceutical Benefits Scheme. Poisson regression was used to calculate rate ratios (RR) for opioid prevalence and incidence. The characteristics of people initiating opioids, including type of opioid initiated, total oral morphine equivalents dispensed, prescriber speciality, medical comorbidities, and past analgesic and benzodiazepine use, were compared for people with and without cancer.
Opioid prevalence increased {RR = 1.006 [95% confidence interval (CI) 1.004, 1.008]}, while incidence decreased [RR = 0.977 (95% CI 0.975,0.979)] from 2013/2014 to 2016/2017. There were between 287 677 and 307 772 prevalent users each year. In total, 769 334 adults initiated opioids between 2013/2014 and 2016/2017, and half of these initiations were by general practitioners. Initiation with a strong opioid occurred in 55.8% of those with cancer and 28.2% of those without cancer.
Rates of opioid use have remained high since 2013, with approximately 3 million adults using opioids and over 1.9 million adults initiating opioids each year. Between 2013 and 2017, opioid prevalence has slightly increased but incidence has decreased. People without cancer account for the majority of opioid use and are more likely to be initiated on short-acting and weak opioids. Initiation of strong opioids has increased over time, reinforcing concerns about increased use and the harms associated with strong opioids in the community.
本研究旨在确定澳大利亚处方类阿片类药物的使用现患率和发生率，并比较有和无癌症患者开始使用处方类阿片类药物的特征。
本研究采用回顾性基于人群的研究设计，通过澳大利亚 2013 年 7 月至 2017 年 6 月期间通过药品福利计划（Pharmaceutical Benefits Scheme）发放处方类阿片类药物的随机 10%成年人样本进行分析。采用泊松回归计算阿片类药物现患率和发生率的率比（RR）。对比了有和无癌症患者开始使用阿片类药物者的特征，包括起始阿片类药物的类型、总口服吗啡等效剂量、处方医师的专业、合并症、过去使用镇痛剂和苯二氮䓬类药物的情况。
2013/2014 年至 2016/2017 年，阿片类药物的现患率[RR=1.006（95%置信区间[CI]：1.004，1.008）]增加，而发生率[RR=0.977（95%CI：0.975，0.979）]下降。每年的现患人数在 287677 至 307772 人之间。在 2013/2014 年至 2016/2017 年期间，共有 769334 名成年人开始使用阿片类药物，其中一半的起始治疗由全科医生进行。有癌症的患者中有 55.8%起始使用强阿片类药物，而无癌症的患者中有 28.2%起始使用强阿片类药物。
自 2013 年以来，阿片类药物的使用率一直居高不下，每年约有 300 万成年人使用阿片类药物，190 多万人开始使用阿片类药物。2013 年至 2017 年期间，阿片类药物的现患率略有上升，但发生率有所下降。无癌症的患者占阿片类药物使用的大多数，更有可能起始使用短效和弱阿片类药物。强阿片类药物的使用量逐年增加，这加剧了人们对社区中强阿片类药物使用增加及其相关危害的担忧。
