Cai Qian, Huang Yun-Ting, Allen Thomas, Morris Charlotte, Grigoroglou Christos, Kontopantelis Evangelos
Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom.
PLoS One. 2025 Jun 26;20(6):e0326604. doi: 10.1371/journal.pone.0326604. eCollection 2025.
To examine trends of opioid use, focusing on long-term opioid therapy (L-TOT) and its discontinuation among people with chronic non-cancer pain (CNCP).
Retrospective cohort study using UK Clinical Practice Research Datalink Aurum data.
Incident opioid users (no opioid use in the prior year) with CNCP between 01/01/2009-31/12/2019. Among them, we identified L-TOT users (≥3 opioid prescriptions within 90 days, or total ≥90 supply days within the first year, excluding the initial 30 days) and L-TOT discontinuers (no opioid use for ≥180 days following a L-TOT).
Yearly rates of incident opioid users (over CPRD-registered patients), L-TOT users (over incident opioid users), and L-TOT discontinuers (over L-TOT users) were calculated. Annual counts of each group were fitted using segmented negative binomial regression models with an offset considering their corresponding denominators from 2009 to 2019, excluding 2014 due to policy changes in that year.
Among 2,839,161 incident opioid users, 11.4% (n = 324,877) transitioned into L-TOT users within one year, of which 4.8% (n = 15,484) discontinued. Between 2009-2013, rates of L-TOT users significantly declined by 2.6% (incidence rate ratio: 0.974; 95% confidence interval: 0.971 to 0.978) per annum, followed by a significant step change in 2015 (1.026, 1.009 to1.044), and a significant annual increase of 2.4% (1.024, 1.019 to 1.029) from 2015 to 2019, compared to the 2009-2013 trend. The annual rates of L-TOT discontinuers remained stable from 2009 to 2013 (0.987, 0.971 to 1.002), followed by a non-significant step change (0.990, 0.916 to 1.070) in 2015, and a significant decrease in slope by 2.6% (0.974, 0.951 to 0.998) per annum during 2015-2019, relative to 2009-2013.
L-TOT has plateaued since 2015, accompanied with an accelerated decrease in discontinuation rates, suggesting ongoing reliance on opioids for CNCP management, despite increased awareness regarding L-TOT associated risks. This is likely due to the limited availability of other effective pharmacological options and non-pharmacological alternatives, and challenges in their accessibility.
研究阿片类药物使用趋势，重点关注长期阿片类药物治疗（L-TOT）及其在慢性非癌性疼痛（CNCP）患者中的停用情况。
使用英国临床实践研究数据链奥鲁姆数据进行回顾性队列研究。
2009年1月1日至2019年12月31日期间患有CNCP的阿片类药物新使用者（前一年未使用阿片类药物）。其中，我们确定了L-TOT使用者（90天内≥3张阿片类药物处方，或第一年供应天数总计≥90天，不包括最初30天）和L-TOT停用者（在L-TOT后≥180天未使用阿片类药物）。
计算阿片类药物新使用者（相对于CPRD注册患者）、L-TOT使用者（相对于阿片类药物新使用者）和L-TOT停用者（相对于L-TOT使用者）的年发生率。使用分段负二项回归模型对每组的年度计数进行拟合，并考虑2009年至2019年（不包括2014年，因为该年政策发生变化）的相应分母进行偏移校正。
在2839161名阿片类药物新使用者中，11.4%（n = 324877）在一年内转变为L-TOT使用者，其中4.8%（n = 15484）停用。2009 - 2013年期间，L-TOT使用者的发生率每年显著下降2.6%（发病率比：0.974；95%置信区间：0.971至0.978），随后在2015年出现显著的阶跃变化（1.026，1.009至1.044），与2009 - 2013年的趋势相比，2015年至2019年每年显著增加2.4%（1.024，1.019至1.029）。2009年至2013年期间，L-TOT停用者的年发生率保持稳定（0.987，0.971至1.002），随后在2015年出现非显著的阶跃变化（0.990，0.916至1.070），相对于2009 - 2013年，2015年至2019年期间斜率每年显著下降2.6%（0.974，0.951至0.998）。
自2015年以来，L-TOT趋于平稳，同时停用率加速下降，这表明尽管对L-TOT相关风险的认识有所提高，但在CNCP管理中对阿片类药物的持续依赖。这可能是由于其他有效药物选择和非药物替代方案的可用性有限，以及获取这些方案存在挑战。
