简介:欧洲处方阿片类药物的使用稳步增加,尤其是非癌症适应症。优化处方需要阿片类药物使用模式的流行病学数据。我们的目标是描述在2012年至2018年期间,在有500万居民的地区,非癌症疼痛的阿片类药物治疗的开始模式和患者的特征。方法:基于人群的回顾性队列研究,对瓦伦西亚地区所有开始阿片类药物治疗非癌性疼痛的成年患者进行研究。我们描述了基线时的患者特征以及基线和后续治疗开始的特征。我们使用多项回归模型来识别与启动相关的个体因素。结果:共有957,080例患者开始了1,509,488例阿片类药物治疗(957,080例基线开始,552,408随后的初始化)。对于基线初始化,738,749人服用曲马多(77.19%),157,098与可待因(16.41%)58,436(6.11%)与长效阿片类药物,1,518(0.16%)使用短效阿片类药物,1,279(0.13%)使用超快药物。与曲马多相比,患者开始短效,长效和超快阿片类药物更可能年龄较大,并有更多的合并症,而使用可待因的起始剂更容易更健康和更年轻。持续少于7天的治疗占初始次数的41.82%,11.89%持续30天以上。19.55%的超快芬太尼引发剂每天接受超过120毫克吗啡当量(MME),16.12%开始服用长效阿片类药物的患者每天服用超过90次的MME(p<0.001)。肌肉骨骼适应症占阿片类药物使用的65.05%。在24.73%的初始化中观察到苯二氮卓类药物的重叠,与加巴喷丁的重叠存在于11.04%的长效阿片类药物的引发剂和28.39%的短效阿片类药物的引发剂同时使用抗精神病药。在随后的初始化中,55.48%的治疗包括三种或更多的处方(与基线初始的17.60%)和重叠的风险也增加。结论:阿片类药物用于大量非肿瘤适应症,and,尽管有临床指南,短效阿片类药物被少量使用,大量患者暴露于潜在的高风险启动模式,例如持续超过14天的治疗,每天超过50个MME的治疗,开始使用长效阿片类药物,或与其他疗法的危险重叠。
Introduction: Europe has seen a steady increase in the use of prescription opioids, especially in non-cancer indications. Epidemiological data on the patterns of use of opioids is required to optimize prescription. We aim to describe the patterns of opioid therapy initiation for non-cancer pain and characteristics of patients treated in a region with five million inhabitants in the period 2012 to 2018. Methods: Population-based retrospective cohort
study of all adult patients initiating opioid therapy for non-cancer pain in the region of Valencia. We described patient characteristics at baseline and the characteristics of baseline and subsequent treatment initiation. We used multinominal regression models to identify individual factors associated with initiation. Results: A total of 957,080 patients initiated 1,509,488 opioid treatments (957,080 baseline initiations, 552,408 subsequent initiations). For baseline initiations, 738,749 were with tramadol (77.19%), 157,098 with codeine (16.41%) 58,436 (6.11%) with long-acting opioids, 1,518 (0.16%) with short-acting opioids and 1,279 (0.13%) with ultrafast drugs. When compared to tramadol, patients initiating with short-acting, long-acting and ultrafast opioids were more likely to be older and had more comorbidities, whereas initiators with codeine were more prone to be healthier and younger. Treatments lasting less than 7 days accounted for 41.82% of initiations, and 11.89% lasted more than 30 days. 19.55% of initiators with ultrafast fentanyl received more than 120 daily Morphine Milligram Equivalents (MME), and 16.12% of patients initiating with long-acting opioids were prescribed more than 90 daily MME (p < 0.001). Musculoskeletal indications accounted for 65.05% of opioid use. Overlap with benzodiazepines was observed in 24.73% of initiations, overlap with gabapentinoids was present in 11.04% of initiations with long-acting opioids and 28.39% of initiators with short-acting opioids used antipsychotics concomitantly. In subsequent initiations, 55.48% of treatments included three or more prescriptions (vs. 17.60% in baseline initiations) and risk of overlap was also increased. Conclusion: Opioids are initiated for a vast array of non-oncological indications, and, despite clinical guidelines, short-acting opioids are used marginally, and a significant number of patients is exposed to potentially high-risk patterns of initiation, such as treatments lasting more than 14 days, treatments surpassing 50 daily MMEs, initiating with long-acting opioids, or hazardous overlapping with other therapies.