Macfarlane Gary J, Beasley Marcus, Jones Gareth T, Stannard Cathy
Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, AB25 2ZD United Kingdom.
NHS Gloucestershire Clinical Commissioning Group, Brockworth, Gloucestershire, GL3 4FE United Kingdom.
EClinicalMedicine. 2020 Apr 18;21:100321. doi: 10.1016/j.eclinm.2020.100321. eCollection 2020 Apr.
Opioids have, at most, small benefits for non-cancer pain in the medium and long-term but there is good evidence that they cause harm. The current study describes the characteristics and clinical status of people taking regular opioids in Great Britain and determines whether use is associated with mortality risk.
An analysis of participants in UK Biobank, a prospective population-based study. At recruitment (2006-10) participants reported medicines which they regularly used in addition to lifestyle and health-related factors. Information was available on deaths until October 2016.
There were 466 486 participants (54% women) aged 40-69 years and without a prior history of cancer of whom 5.5% were regularly using opioids. Use increased with age-group, was more common in females (6.3% v. 4.6%) and 87% of persons using them reported chronic pain. The highest rates of use (~1 in 9) were in people with low household income, who left school <16 years and lived in areas with high deprivation. Amongst 15,032 people who could not work because of ill-health, 1 in 3 were regularly taking opioids. Regular users reported insomnia (88.7%), a recent major recent life event (57.3%) and were much more likely than non-users to rate their health as poor (RR 5.5, 99% CI (4.9, 6.1)). Those taking weak (4.2% of participants) or strong (1.4%) opioids were more likely to die during follow-up (6.9% and 9.1% respectively v. 3.3% in non-users) an excess which remained after adjustment for demographic, socio-economic, health and lifestyle factors (MRR 1.18 99% CI (1.06, 1.32) and 1.20 99% CI (1.01, 1.43)) respectively.
Regular use of opioids is common in Great Britain, particularly in groups of low socio-economic status. Most users still report chronic pain, poor health generally and are at increased risk of premature death although it is not established that this relationship is causal.
There were no external sources of funding obtained for the current analyses.
阿片类药物对非癌性疼痛的中长期益处至多微乎其微，但有充分证据表明它们会造成伤害。本研究描述了英国定期服用阿片类药物人群的特征和临床状况，并确定使用阿片类药物是否与死亡风险相关。
对英国生物银行的参与者进行分析，这是一项基于人群的前瞻性研究。在招募阶段（2006 - 2010年），参与者报告了他们定期使用的药物以及生活方式和健康相关因素。可获取截至2016年10月的死亡信息。
共有466486名年龄在40 - 69岁且无癌症病史的参与者（54%为女性），其中5.5%的人定期使用阿片类药物。使用率随年龄组增加，在女性中更常见（6.3%对4.6%），87%使用阿片类药物的人报告有慢性疼痛。使用率最高的人群（约九分之一）是家庭收入低、16岁前辍学且生活在贫困程度高的地区的人。在15032名因健康不佳而无法工作的人中，三分之一的人定期服用阿片类药物。定期使用者报告有失眠（88.7%）、近期有重大生活事件（57.3%），并且他们将自己的健康状况评为差的可能性比非使用者高得多（相对风险5.5，99%置信区间（4.9，6.1））。服用弱阿片类药物（占参与者的4.2%）或强阿片类药物（1.4%）的人在随访期间死亡的可能性更高（分别为6.9%和9.1%，而非使用者为3.3%），在对人口统计学、社会经济、健康和生活方式因素进行调整后，这种差异仍然存在（多变量相对风险分别为1.18，99%置信区间（1.06，1.32）和1.20，99%置信区间（1.01，1.43））。
在英国，定期使用阿片类药物很常见，尤其是在社会经济地位较低的群体中。大多数使用者仍报告有慢性疼痛、总体健康状况不佳且过早死亡风险增加，尽管尚未确定这种关系是因果关系。
本次分析未获得外部资金来源。
