Examining patterns in opioid prescribing for non-cancer-related pain in Wales: preliminary data from a retrospective cross-sectional study using large datasets

Objectives: To examine trends in strong opioid prescribing in a
primary care population in Wales and identify if factors such as age,
deprivation and recorded diagnosis of depression or anxiety may have
influenced any changes noted. Design: Trend, cross-sectional and
longitudinal analyses of routine data from the Primary Care General
Practice database and accessed via the Secure Anonymised Information
Linkage (SAIL) databank. Setting: A total of 345 Primary
Care practices in Wales. Participants: Anonymised records of
1,223,503 people aged 18 or over, receiving at least one opioid pre-
scription between 1 January 2005 and 31 December 2015 were analysed.
People with a cancer diagnosis (10.1%) were excluded from the detailed
analysis. Results: During the study period, 26,180,200 opioid
prescriptions were issued to 1,223,503 individuals (55.9% female, 89.9%
non-cancer diagnoses). The greatest increase in annual prescribing was in
the 18–24 age group (10,470%), from 0.08 to 8.3 prescriptions/1000
population, although the 85+ age group had the highest
prescribing rates across the study period (from 149.9 to 288.5
prescriptions/1000 popu- lation). The number of people with recorded
diagnoses of depression or anxiety and prescribed strong opioids increased
from 1.2 to 5.1 people/1000 population (328%). The increase was 366.9% in
areas of highest deprivation compared to 310.3 in the least. Areas of
greatest deprivation had more than twice the rate of strong opioid
prescribing than the least deprived areas of Wales.
Conclusion: The study highlights a large increase in strong
opioid prescribing for non-cancer pain, in Wales between 2005 and 2015.
Population groups of interest include the youngest and oldest adult age
groups and people with depression or anxiety particularly if living in the
most deprived communities. Based on this evidence, development of a Welsh
national guidance on safe and rational prescribing of opioids in chronic
pain would be advisable to prevent further escalation of these medicines.

研究目的：旨在探析威尔士基层医疗人群中强效阿片类药物处方的变化趋势，并明确年龄、社会剥夺程度、已记录的抑郁或焦虑诊断等因素是否对观测到的处方变化存在影响。
研究设计：基于常规医疗数据开展趋势分析、横断面分析与纵向分析，数据源自基层全科医疗数据库，并通过安全匿名信息链接（Secure Anonymised Information Linkage, SAIL）数据库获取。
研究场景：威尔士共计345家基层全科医疗诊所。
研究对象：本研究对2005年1月1日至2015年12月31日期间，1223503名年龄≥18岁且至少存在1次阿片类药物处方记录的匿名医疗记录进行分析。其中，伴有癌症诊断的人群（占总研究对象的10.1%）被排除于详细分析环节。
研究结果：研究周期内，共计向1223503名个体开具了26180200张阿片类药物处方（其中女性占比55.9%，非癌症诊断人群占比89.9%）。18-24岁年龄组的年处方量增幅最为显著，达10470%，处方率从每千人0.08张升至8.3张；但85岁及以上年龄组在整个研究周期内的处方率始终最高，从每千人149.9张升至288.5张。伴有抑郁或焦虑诊断且开具强效阿片类药物处方的人群占比，从每千人1.2人升至5.1人，增幅达328%。其中，社会剥夺程度最高的地区增幅为366.9%，社会剥夺程度最低的地区增幅为310.3%。社会剥夺程度最高的地区，其强效阿片类药物处方率是威尔士社会剥夺程度最低地区的两倍以上。
研究结论：本研究显示，2005年至2015年间，威尔士针对非癌性疼痛的强效阿片类药物处方量大幅攀升。值得重点关注的人群包括青年及老年成年群体，以及伴有抑郁或焦虑诊断的人群，尤其是居住在社会剥夺程度最高社区的此类个体。基于本研究证据，建议制定威尔士国家级慢性疼痛阿片类药物安全合理使用指南，以遏制此类药物的进一步滥用与处方升级。