Monash Adiction Research Centre, Eastern Health Clinical School, Victoria, Australia.
Turning Point, Eastern Health and Eastern Health Clinical School, Monash University, Victoria, Australia.
Addiction. 2021 Aug;116(8):2233-2241. doi: 10.1111/add.15365. Epub 2021 Jan 4.
In Australia, oxycodone has been associated with increasing rates of harm over time, despite reduced use, reformulation to a tamper-resistant form and in contrast to most prescription opioids. We explored characteristics of oxycodone-related ambulance attendances to understand whether presentation characteristics could explain increasing oxycodone harm.
Retrospective study of coded ambulance patient care records related to extramedical oxycodone use, January 2013 to September 2018.
Victoria, Australia.
A total of 2788 oxycodone-related ambulance attendances.
Primary outcomes were temporal changes in characteristics of oxycodone presentations over time (from 2013 to 2018) and following reformulation. Covariates include demographic characteristics, presentation severity, mental health, substance use and poisoning intent.
Average age was 41.3 (± 16.4) years with females comprising 56.4% of attendances (n = 2788). The proportion of females in oxycodone-related attendances increased over time [an average increase in the odds ratios of 5% per year (OR) = 1.05, 95% confidence interval (CI) = 1.01-1.10]. Other temporal trends included a reduced likelihood of naloxone administration (OR = 0.92, 95% CI = 0.85-1.00), heroin involvement (OR = 0.81, 95% CI = 0.66-0.99), comorbid mental health symptoms (OR = 0.87, 95% CI = 0.82-0.92) and unknown intent poisoning (OR = 0.91, 95% CI = 0.85-0.96); and a greater risk of alcohol involvement (OR = 1.06, 95% CI = 1.01-1.11), non-opioid extramedical pharmaceutical use (OR = 1.05, 95% CI = 1.01-1.10), comorbid suicidal thoughts or behaviours (OR = 1.10, 95% CI = 1.05-1.15) and past history of psychiatric issues (OR = 1.22, 95% CI = 1.16-1.27). Interrupted time-series analysis showed that reformulation was associated with an immediate effect on sex, severity, accidental poisoning and unknown intent poisoning, although these were not sustained over time. Alcohol involvement in the attendance (OR = 1.43, 95% CI = 1.17-1.74, i.e. an average increase in the odds of 43% per year), Glasgow Coma Scale (OR = 1.28, 95%CI 1.04 - 1.57), a previous history of psychiatric issues (OR = 0.80, 95% CI = 0.70-0.92, i.e. an average decrease in the odds of 20% per year, heroin involvement (OR = 0.22, 95% CI = 0.05 - 0.98) and illicit drug use (OR = 0.45, 95% CI = 0.23 - 0.87) showed statistically significant relative changes following the reformulation.
The characteristics of oxycodone presentations in Australian ambulances attendances appear to be changing over time, including more female presentations; increasing alcohol use, extramedical use of non-opioid pharmaceuticals and suicidal thoughts or behaviours and decreasing heroin and illicit drug involvement.
在澳大利亚，尽管奥施康定的使用减少、剂型改为防篡改形式，但与大多数处方类阿片类药物相比，其造成的伤害却在不断增加。我们探究了奥施康定相关救护车就诊的特征，以了解呈现特征是否可以解释奥施康定伤害的增加。
对 2013 年 1 月至 2018 年 9 月与非医疗用途奥施康定相关的救护车患者护理记录进行回顾性研究。
澳大利亚维多利亚州。
共 2788 例奥施康定相关救护车就诊。
主要结局指标是奥施康定呈现特征随时间（2013 年至 2018 年）和剂型改革的变化。协变量包括人口统计学特征、就诊严重程度、心理健康、物质使用和中毒意图。
平均年龄为 41.3（±16.4）岁，女性占就诊人数的 56.4%（n=2788）。奥施康定相关就诊中女性的比例随时间增加[平均每年增加 5%的比值比（OR）=1.05，95%置信区间（CI）=1.01-1.10]。其他时间趋势包括纳洛酮给药的可能性降低（OR=0.92，95%CI=0.85-1.00）、海洛因参与（OR=0.81，95%CI=0.66-0.99）、共病心理健康症状（OR=0.87，95%CI=0.82-0.92）和未知意图中毒（OR=0.91，95%CI=0.85-0.96）；酒精摄入风险增加（OR=1.06，95%CI=1.01-1.11）、非阿片类药物非医疗用途药物使用（OR=1.05，95%CI=1.01-1.10）、共病自杀意念或行为（OR=1.10，95%CI=1.05-1.15）和过去精神科问题史（OR=1.22，95%CI=1.16-1.27）。中断时间序列分析显示，剂型改革立即对性别、严重程度、意外中毒和未知意图中毒产生影响，尽管这些影响并未持续。在就诊中酒精摄入（OR=1.43，95%CI=1.17-1.74，即每年增加 43%的几率）、格拉斯哥昏迷量表（OR=1.28，95%CI 1.04-1.57）、以前的精神科问题史（OR=0.80，95%CI=0.70-0.92，即每年减少 20%的几率）、海洛因参与（OR=0.22，95%CI=0.05-0.98）和非法药物使用（OR=0.45，95%CI=0.23-0.87）在剂型改革后呈现出统计学上显著的相对变化。
澳大利亚救护车就诊中奥施康定呈现的特征似乎随时间发生变化，包括女性就诊人数增加；酒精使用、非阿片类药物非医疗用途药物使用和自杀意念或行为增加，而海洛因和非法药物使用减少。
