Maryborough Hospital Pharmacy, Wide Bay Hospital and Health Service, 185 Walker Street Maryborough 4650, Herston, QLD, Australia.
Discipline of Psychiatry, The University of Queensland, Herston, QLD, 4029, Australia.
Int J Clin Pharm. 2021 Apr;43(2):340-350. doi: 10.1007/s11096-020-01079-0. Epub 2020 Jun 16.
Background There is an association between the duration of prescription opioids use and an increased risk of serious harm, often unintentional. Objective (1) Describe the trends in duration of prescription opioids dispensing and, (2) determine the risk of long-term use (≥4 months) based on patients' socioeconomic status, daily dose in oral daily morphine milligram equivalent, and opioid formulation. Setting Residents of Queensland (2,827,727), Australia from the age 18 years and who were dispensed pharmaceutical opioids from 1 January 1997 to 31 December 2018. Method Retrospective, longitudinal population-based analysis using data obtained from the Monitoring of Drugs of Dependence system of the Monitored Medicines Unit of Queensland Health. Main outcome measure Contribution of socioeconomic status, and daily dose and opioid formulation (modified-release or immediate-release) to the risk of long-term opioid use. Results There was little difference between the number of patients dispensed opioids for ≥4 months and ≤3 months between 1997 and 2011. Thereafter, the number for those using opioids long-term increased. The highest risk of having opioids dispensed for ≥4 months were for patients in the lowest level of socioeconomic status (adjusted odds ratio 1.36; 95% CI, 1.34, 1.38), compared to people in the highest socioeconomic status areas, followed by the low-socioeconomic status areas, mid-socioeconomic status areas, and high-socioeconomic status areas respectively. The risk of being dispensed prescription opioids for ≥4 months significantly increased as the dose increased: adjusted odds ratio 1.73; 95% CI, 1.71, 1.75, adjusted odds ratio 1.89; 95% CI, 1.87, 1.92, and adjusted odds ratio 3.63; 95% CI, 3.58, 3.69 for the ≥20 to <50 oral daily morphine milligram equivalent, ≥50 to <100 oral daily morphine milligram equivalent and ≥100 oral daily morphine milligram equivalent dose categories, respectively. Conclusion Higher doses and living in a low socioeconomic status areas were associated with increased risk of long-term dispensing of opioid prescriptions.
处方类阿片类药物使用时间的长短与严重伤害风险增加有关，且这种伤害往往是无意造成的。
（1）描述处方类阿片类药物配给时长的变化趋势，（2）根据患者的社会经济地位、口服每日吗啡毫克当量剂量、阿片类药物剂型，确定长期使用（≥4 个月）的风险。
澳大利亚昆士兰州（2827727 人），年龄在 18 岁及以上，并于 1997 年 1 月 1 日至 2018 年 12 月 31 日期间从昆士兰卫生署监测药物单位的药物依赖监测系统获得药物。
使用纵向回顾性人群分析方法，对从 1997 年至 2011 年期间的监测药物单位的药物依赖监测系统的数据进行分析。
社会经济地位、日剂量和阿片类药物剂型（缓释或速释）对长期使用阿片类药物风险的影响。
1997 年至 2011 年期间，长期使用阿片类药物（≥4 个月）的患者人数与短期使用阿片类药物（≤3 个月）的患者人数相差不大。此后，长期使用阿片类药物的患者人数增加。在社会经济地位最低的患者中，开具≥4 个月的阿片类药物的风险最高（调整后比值比为 1.36；95%可信区间为 1.34、1.38），其次是社会经济地位较低的地区、社会经济地位中等的地区和社会经济地位较高的地区。随着剂量的增加，开具≥4 个月的处方类阿片类药物的风险显著增加：调整后比值比为 1.73；95%可信区间为 1.71、1.75，调整后比值比为 1.89；95%可信区间为 1.87、1.92，调整后比值比为 3.63；95%可信区间为 3.58、3.69，分别对应≥20 至<50 口服每日吗啡毫克当量、≥50 至<100 口服每日吗啡毫克当量和≥100 口服每日吗啡毫克当量剂量类别。
较高的剂量和较低的社会经济地位地区与长期开具阿片类药物处方的风险增加有关。
