Xie Junqing, Strauss Victoria Y, Collins Gary S, Khalid Sara, Delmestri Antonella, Turkiewicz Aleksandra, Englund Martin, Tadrous Mina, Reyes Carlen, Prieto-Alhambra Daniel
Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom.
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
Front Pharmacol. 2022 Jun 8;13:912361. doi: 10.3389/fphar.2022.912361. eCollection 2022.
To characterize the trend of opioid use (number of users, dispensations and oral morphine milligram equivalents) in Catalonia (Spain). This population-based cohort study included all individuals aged 18 years or older, registered in the Information System for Research in Primary Care (SIDIAP), which covers >75% of the population in Catalonia, Spain, from 1 January 2007, to 31 December 2019. The exposures were all commercialized opioids and their combinations (ATC-codes): codeine, tramadol, oxycodone, tapentadol, fentanyl, morphine, and other opioids (dihydrocodeine, hydromorphone, dextropropoxyphene, buprenorphine, pethidine, pentazocine). The main outcomes were the annual figures per 1,000 individuals of 1) opioid users, 2) dispensations, and 3) oral morphine milligram equivalents (MME). Results were stratified separately by opioid types, age (5-year age groups), sex (male or female), living area (rural or urban), and socioeconomic status (from least, U1, to most deprived, U5). The overall trends were quantified using the percentage change (PC) between 2007 and 2019. Among 4,656,197 and 4,798,114 residents from 2007 to 2019, the number of opioid users, dispensations and morphine milligram equivalents per 1,000 individuals increased 12% (percentage change: 95% confidence interval (CI) 11.9-12.3%), 105% (95% confidence interval 83%-126%) and 339% (95% CI 289%-390%) respectively. Tramadol represented the majority of opioid use in 2019 (61, 59, and 54% of opioid users, dispensations, and total MME, respectively). Individuals aged 80 years or over reported the sharpest increase regarding opioid users (PC: 162%), dispensations (PC: 424%), and MME (PC: 830%). Strong opioids were increasingly prescribed for non-cancer pains over the years. Despite the modest increase of opioid users, opioid dispensations and MME increased substantially, particularly in the older population. In addition, strong opioids were incrementally indicated for non-cancer pains over the years. These findings suggest a transition of opioid prescriptions from intermittent to chronic and weak to strong and call for more rigorous opioid stewardship.
为了描述西班牙加泰罗尼亚地区阿片类药物的使用趋势（使用者数量、配药量及口服吗啡毫克当量）。这项基于人群的队列研究纳入了所有年龄在18岁及以上、在初级医疗研究信息系统（SIDIAP）中注册的个体，该系统覆盖了西班牙加泰罗尼亚地区超过75%的人口，研究时间从2007年1月1日至2019年12月31日。暴露因素为所有商业化的阿片类药物及其组合（解剖学治疗学及化学分类代码）：可待因、曲马多、羟考酮、他喷他多、芬太尼、吗啡及其他阿片类药物（二氢可待因、氢吗啡酮、右丙氧芬、丁丙诺啡、哌替啶、喷他佐辛）。主要结局指标为每1000人中1）阿片类药物使用者数量、2）配药量、3）口服吗啡毫克当量（MME）的年度数据。结果按阿片类药物类型、年龄（5岁年龄组）、性别（男性或女性）、居住地区（农村或城市）及社会经济地位（从最贫困的U1到最富裕的U5）分别进行分层。使用2007年至2019年期间的百分比变化（PC）对总体趋势进行量化。在2007年至2019年的4656197名和4798114名居民中，每1000人中阿片类药物使用者数量、配药量及吗啡毫克当量分别增加了12%（百分比变化：95%置信区间（CI）11.9 - 12.3%）、105%（95%置信区间83% - 126%）和339%（95% CI 289% - 390%）。2019年曲马多在阿片类药物使用中占比最大（分别占阿片类药物使用者的61%、配药量的59%和总MME的54%）。80岁及以上的个体在阿片类药物使用者数量（PC：162%）、配药量（PC：424%）和MME（PC：830%）方面的增长最为显著。多年来，强效阿片类药物越来越多地被用于非癌性疼痛。尽管阿片类药物使用者数量略有增加，但阿片类药物配药量和MME大幅增加，尤其是在老年人群中。此外，多年来强效阿片类药物越来越多地被用于非癌性疼痛。这些发现表明阿片类药物处方从间歇性向慢性、从弱效向强效转变，需要更严格的阿片类药物管理。
