National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.
School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
JAMA Netw Open. 2023 Aug 1;6(8):e2328159. doi: 10.1001/jamanetworkopen.2023.28159.
There are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation.
To identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study conducted in New South Wales, Australia, linked national pharmaceutical claims data to 10 national and state data sets to determine sociodemographic characteristics, clinical characteristics, drug use, and health services use. The cohort included adult residents (aged ≥18 years) of New South Wales who initiated a prescription opioid between July 1, 2003, and December 31, 2018. Statistical analyses were conducted from February to September 2022.
Dispensing of a prescription opioid, with no evidence of opioid dispensing in the preceding 365 days, identified from pharmaceutical claims data.
The main outcome was the trajectories of monthly opioid use over 60 months from opioid initiation. Group-based trajectory modeling was used to classify these trajectories. Linked health care data sets were used to examine characteristics of individuals in different trajectory groups.
Among 3 474 490 individuals who initiated a prescription opioid (1 831 230 females [52.7%]; mean [SD] age, 49.7 [19.3] years), 5 trajectories of long-term opioid use were identified: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). Compared with individuals in the very low use trajectory group, those in the sustained use trajectory group were older (age ≥65 years: 22.0% vs 58.4%); had more comorbidities, including cancer (4.1% vs 22.2%); had increased health services contact, including hospital admissions (36.9% vs 51.6%); had higher use of psychotropic (16.4% vs 42.4%) and other analgesic drugs (22.9% vs 47.3%) prior to opioid initiation, and were initiated on stronger opioids (20.0% vs 50.2%).
Results of this cohort study suggest that most individuals commencing treatment with prescription opioids had relatively low and time-limited exposure to opioids over a 5-year period. The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.
长期使用阿片类药物存在已知风险。然而，对于初始使用后阿片类药物的长期使用轨迹知之甚少。
确定处方类阿片药物使用的 5 年轨迹，并检查每个轨迹组的特征。
设计、设置和参与者：这项基于人群的队列研究在澳大利亚新南威尔士州进行，将国家药品报销数据与 10 个国家和州数据集进行了链接，以确定社会人口统计学特征、临床特征、药物使用和卫生服务使用情况。该队列包括新南威尔士州的成年居民（年龄≥18 岁），他们在 2003 年 7 月 1 日至 2018 年 12 月 31 日期间开始使用处方类阿片药物。统计分析于 2022 年 2 月至 9 月进行。
从药品报销数据中确定处方类阿片药物的配药情况，没有证据表明在过去 365 天内有阿片类药物的配药。
主要结局是从阿片类药物初始使用开始的 60 个月内每月阿片类药物使用的轨迹。使用基于群组的轨迹建模来对这些轨迹进行分类。链接的卫生保健数据集用于检查不同轨迹组中个体的特征。
在 3474490 名开始使用处方类阿片药物的个体中（1831230 名女性[52.7%]；平均[标准差]年龄，49.7[19.3]岁），确定了 5 种长期阿片类药物使用轨迹：极低使用（75.4%）、低使用（16.6%）、逐渐减少到低使用（2.6%）、低增加到中等使用（2.6%）和持续使用（2.8%）。与极低使用轨迹组的个体相比，持续使用轨迹组的个体年龄更大（年龄≥65 岁：22.0% vs 58.4%）；合并症更多，包括癌症（4.1% vs 22.2%）；接触更多的卫生服务，包括住院治疗（36.9% vs 51.6%）；在开始使用阿片类药物之前，使用精神类药物（16.4% vs 42.4%）和其他镇痛药（22.9% vs 47.3%）的频率更高，并且使用的阿片类药物更强（20.0% vs 50.2%）。
这项队列研究的结果表明，大多数开始接受处方类阿片药物治疗的个体在 5 年内接触阿片类药物的时间相对较短，且剂量有限。少数持续或增加使用的个体年龄较大，合并症更多，使用精神类药物和其他镇痛药更多，这可能反映出这些个体疼痛和治疗需求的发生率更高。
