Department of Public Health, La Trobe University, Melbourne, Victoria, Australia.
Health Information Management, Department of Public Health, La Trobe University, Melbourne, Victoria, Australia.
PLoS One. 2019 Aug 19;14(8):e0221438. doi: 10.1371/journal.pone.0221438. eCollection 2019.
Inappropriate utilization of prescription opioids and benzodiazepines is a public health problem. This study examined and compared user-types and trends in dispensing of these medicines, and identified associated factors related to the duration of dispensing in Australia.
A random 10% sample of unit-record data of opioids and benzodiazepines dispensed nationally during 2013-2016 was analyzed. Users were categorized into four types: single-quarter (i.e., three months), medium-episodic (dispensed 2-6 quarters), long-episodic (dispensed 7-11 quarters), chronic (dispensed 12-16 quarters). Dispensing quantity was computed in defined daily dose (DDD). Generalized multilevel ordinal models were developed to examine the factors associated with the duration of dispensing.
There were similarities in terms of trends of dispensing of opioids and benzodiazepines in Australia. Overall, more people were dispensed opioids than benzodiazepines. Around 52% of opioids users and 46% of benzodiazepines users were dispensed these medicines for a single quarter. However, chronic users were dispensed 60% of opioids and 50% of benzodiazepines in DDD/1000 people/day, respectively. On average, 16.6 DDD/1000 people/day of opioids and 14.2 DDD/1000 people/day of benzodiazepines were dispensed in Australia during the study period. Tasmania was dispensed the highest quantity (in DDD/1000 people/day) of these medicines, followed by South Australia and Queensland. Women compared to men, and clients of age-group 20-44, 45-64 and 65+ compared to age-group 0-19, were significantly more likely to have dispensed opioids/benzodiazepine for a relatively long duration. Clients with a history of dispensing of one of these two medicines were significantly more likely to have dispensed the other for a relatively long period.
There were similarities in patterns of dispensing of opioids and benzodiazepines in terms of user characteristics and structural variables. Consistent use of real-time drug monitoring program and tailored intervention are recommended.
处方类阿片和苯二氮䓬类药物的不当使用是一个公共卫生问题。本研究考察并比较了这些药物在澳大利亚的配药用户类型和趋势，并确定了与配药持续时间相关的相关因素。
对 2013-2016 年期间全国范围内配给阿片类药物和苯二氮䓬类药物的单位记录数据的 10%随机样本进行了分析。用户分为以下四类：单季度（即三个月）、中发性（配药 2-6 个季度）、长发性（配药 7-11 个季度）、慢性（配药 12-16 个季度）。配药数量以规定日剂量（DDD）计算。开发了广义多级有序模型来研究与配药持续时间相关的因素。
澳大利亚在阿片类药物和苯二氮䓬类药物的配药趋势方面存在相似之处。总体而言，配给阿片类药物的人数多于苯二氮䓬类药物。大约 52%的阿片类药物使用者和 46%的苯二氮䓬类药物使用者在单季度内配药。然而，慢性使用者分别以 DDD/1000 人/天 60%的阿片类药物和 50%的苯二氮䓬类药物配药。在研究期间，澳大利亚平均每天有 16.6 DDD/1000 人配给阿片类药物和 14.2 DDD/1000 人配给苯二氮䓬类药物。塔斯马尼亚州配给的这些药物数量（DDD/1000 人/天）最高，其次是南澳大利亚州和昆士兰州。与男性相比，女性以及 20-44 岁、45-64 岁和 65 岁以上的年龄组客户更有可能长期配给阿片类药物/苯二氮䓬类药物。有配给这两种药物之一历史的客户更有可能长期配给另一种药物。
在用户特征和结构变量方面，阿片类药物和苯二氮䓬类药物的配药模式存在相似之处。建议一致使用实时药物监测计划和量身定制的干预措施。
