AIMS To characterise the trajectory in the years leading up to 2018 in pharmaceutical-opioid and heroin morbidity in Victoria, Australia, and to assess the effect on that trajectory of reformulation of oxycodone to a form that could not be easily snorted or injected. DESIGN Interrupted time series analyses of population-level data before versus after reformulation of oxycodone, stratified by sex. SETTING Victoria, Australia. PARTICIPANTS The population of Victoria aged 12+ years. MEASUREMENTS Ambulance patient care and Emergency Department (ED) records were examined using both fixed-code and free-text fields, with each record manually cleaned and checked by trained coders. These were used to derive the output variables providing an index of harm: rates of opioid-related ambulance attendances and emergency department (ED) attendances for pharmaceutical opioids and heroin. The input variable was pre- versus post oxycodone reformulation. FINDINGS There were 30,045 (58% male) opioid-related ambulance attendances from January 2012-October 2018, and 10,113 (51% male) ED attendances from July 2008-June 2018. There was an increase in the rate (events per 100,000 persons per year) of all-opioid ED attendances from 2008-2018 (increase: 0.063; 95% CI: 0.049,0.078). Pharmaceutical-opioid ED attendances decreased from 2014 onwards (slope change:-0.083; 95%CI:-0.108,-0.059). Heroin-related ED attendances increased from 2014 to 2018; 11,324 heroin-related ambulance attendances and 1,980 ED attendances were observed from April 2014 to June 2018, compared with the respective estimates of 8,176 and 1,661 had the pre-April 2014 trend continued (ambulance slope change:0.296, 95%CI:0.104,0.489; ED slope change:0.026, 95% CI:0.005,0.046). The inflection point of 2014 coincided with the reformulation of oxycodone. CONCLUSION In Victoria, Australia, there appears to have been a trend starting around mid-2014 of increasing heroin-related harm, and a flattening of the increase or a decrease of harms relating to pharmaceutical opioids. These changes may in part reflect reformulation of oxycodone to reduce the extent to which it can be injected or snorted.

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截至 2018 年澳大利亚维多利亚州海洛因和药物阿片类药物相关危害的趋势

目的 描述澳大利亚维多利亚州截至 2018 年药物阿片类药物和海洛因发病率的轨迹，并评估将羟考酮重新配制为不易吸入或注射的形式对该轨迹的影响。设计 对羟考酮重新配制之前和之后的人口水平数据的中断时间序列分析，按性别分层。设置澳大利亚维多利亚。参与者 维多利亚州 12 岁以上的人口。测量 使用固定代码和自由文本字段检查救护车患者护理和急诊科 (ED) 记录，每条记录均由经过培训的编码人员手动清理和检查。这些用于导出提供伤害指数的输出变量：阿片类药物相关的救护车就诊率和药物阿片类药物和海洛因的急诊科 (ED) 就诊率。输入变量是羟考酮重新配制前后。结果 2012 年 1 月至 2018 年 10 月期间有 30,045（58% 男性）阿片类药物相关救护车就诊，2008 年 7 月至 2018 年 6 月期间有 10,113（51% 男性）急诊部就诊。 2008-2018 年全阿片类急诊就诊人数（增加：0.063；95% CI：0.049,0.078）。自 2014 年起，药物阿片类急诊就诊人数下降（斜率变化：-0.083；95% CI：-0.108,-0.059）。从 2014 年到 2018 年，海洛因相关急诊就诊人数有所增加；从 2014 年 4 月到 2018 年 6 月，观察到 11,324 次与海洛因相关的救护车就诊和 1,980 次急诊就诊，而分别估计为 8,176 和 1，661 人延续了 2014 年 4 月之前的趋势（救护车斜率变化：0.296，95%CI：0.104,0.489；ED 斜率变化：0.026，95% CI：0.005,0.046）。2014年的拐点恰逢羟考酮的重新配制。结论 在澳大利亚维多利亚州，似乎在 2014 年年中左右开始出现海洛因相关危害增加的趋势，与药物类阿片相关危害的增加或减少趋于平缓。这些变化可能部分反映了羟考酮的重新配制，以减少注射或吸入的程度。从 2014 年年中左右开始，海洛因相关危害似乎有增加的趋势，与药物类阿片相关危害的增加或减少趋于平缓。这些变化可能部分反映了羟考酮的重新配制，以减少注射或吸入的程度。从 2014 年年中左右开始，海洛因相关危害似乎有增加的趋势，与药物类阿片相关危害的增加或减少趋于平缓。这些变化可能部分反映了羟考酮的重新配制，以减少注射或吸入的程度。