BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Addiction. 2021 Dec;116(12):3422-3432. doi: 10.1111/add.15515. Epub 2021 Apr 29.
Prescription opioid analgesics have contributed to the development of opioid use disorder (OUD) in many individuals. We aimed to characterize non-cancer opioid prescribing for opioid-naive individuals prior to OUD identification.
Population-based retrospective cohort study using six linked health administrative databases.
British Columbia (BC), Canada.
People with OUD between 1 January 2001 and 30 September 2018 who initiated opioid analgesic therapy for non-cancer pain prior to OUD identification.
Dose (morphine milligram equivalent per day), days prescribed and clinical guideline non-concordance for initial opioid prescriptions (dose ≥ 90 morphine milligram equivalent per day; ≥ 7 days prescribed; concomitant sedative prescription). We estimated the probability of non-concordant initial prescriptions by source (inpatient post-discharge, non-inpatient acute, non-acute) using logistic regression, adjusting for individual characteristics and comorbidities.
Among 66 372 individuals identified with OUD from 2001 to 2018, 21 331 (32.1%) received opioid analgesics prior to OUD identification. This proportion increased from 3.0% in 2001 to 41.0% in 2011, before decreasing to 34.2% in 2017. Roughly half of opioid prescriptions were attributed to non-acute care visits, peaking at 56.8% in 2007, while the proportion from inpatient visits increased from 19.7% in 2001 to 28.5% in 2017. The predicted probability of receiving non-guideline concordant prescriptions declined over time-periods across all three measures for inpatient and non-inpatient acute care, while remaining stable for non-acute care. In particular, the predicted probability of receiving ≥ 7-day prescriptions following inpatient visits decreased from 53.3% [95% confidence interval (CI) = 50.9, 55.8%] in 2001-06 to 37.2% (95% CI = 33.9, 40.5%) in 2013-18.
Among the 66 372 individuals in British Columbia, Canada diagnosed with opioid use disorder between 2001 and 2018, more than 32% were earlier prescribed non-cancer opioid analgesics. The proportion who had received an opioid analgesic prescription prior to OUD identification peaked at more than 40% in 2011, before stabilizing between 2011 and 2016 and declining thereafter. Guideline concordance improved over time for high-dose and concomitant sedative prescribing.
处方类阿片类镇痛药已导致许多人出现阿片类药物使用障碍（OUD）。本研究旨在描述 OUD 确诊前，初始接受阿片类药物治疗的阿片类药物-naive 个体的非癌症类阿片类药物处方情况。
采用 6 个健康管理数据库进行的基于人群的回顾性队列研究。
加拿大不列颠哥伦比亚省（BC）。
2001 年 1 月 1 日至 2018 年 9 月 30 日期间，OUD 确诊前接受非癌症疼痛的阿片类药物镇痛治疗且此前未使用过阿片类药物的个体。
初始阿片类药物处方的剂量（每日吗啡毫克当量）、天数和临床指南的一致性（剂量≥90 吗啡毫克当量/天；≥7 天处方；同时开具镇静剂处方）。我们使用逻辑回归估计了不同来源（出院后住院、非住院急性、非急性）初始非一致性处方的概率，调整了个体特征和合并症。
2001 年至 2018 年期间，在 66372 名确诊为 OUD 的个体中，21331 名（32.1%）在 OUD 确诊前接受了阿片类药物治疗。这一比例从 2001 年的 3.0%上升到 2011 年的 41.0%，然后在 2017 年下降到 34.2%。大约一半的阿片类药物处方归因于非急性护理就诊，2007 年达到峰值 56.8%，而住院就诊的比例从 2001 年的 19.7%上升到 2017 年的 28.5%。所有三种措施的住院和非住院急性护理时间内，接受非指南一致处方的预测概率随时间呈下降趋势，而非急性护理的预测概率保持稳定。特别是，与 2001-06 年相比，2013-18 年期间，住院后接受≥7 天处方的预测概率从 53.3%（95%置信区间[CI]为 50.9%，55.8%）下降到 37.2%（95%CI 为 33.9%，40.5%）。
在 2001 年至 2018 年期间，在加拿大不列颠哥伦比亚省被诊断为 OUD 的 66372 名个体中，超过 32%的个体此前曾接受过非癌症类阿片类药物镇痛治疗。在 2011 年，有超过 40%的人接受了阿片类药物处方，在此之前，该比例在 2011 年至 2016 年之间稳定，此后开始下降。高剂量和同时开具镇静剂的指南一致性随着时间的推移而提高。
