BACKGROUND AND AIMS Strong and high-dose opioids are associated with opioid overdose and death. The objective of this study was to determine the rate and predictors of transitioning to high-dose or strong opioids among people initiating opioids. DESIGN Retrospective cohort study. SETTING Australia. PARTICIPANTS People initiating opioid analgesics from July 2013 to January 2018 were identified from a random 10% sample of Australia's Pharmaceutical Benefits Scheme eligible population. MEASUREMENTS Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the predictors of escalating to ≥50 mg Oral Morphine Equivalents (OMEs)/day (Cohort 1); ≥90 mg OMEs/day (Cohort 2) and transitioning from weak opioids to strong opioids (Cohort 3) over 12 months of follow-up. Predictors included age, sex, number of comorbidities, history of depression, prior treatment for cancer, and selected other medication use. FINDINGS In total, 861,691 people initiated opioids at average doses <50mg OMEs/day (Cohort 1), 874,401 at <90mg OMEs/day (Cohort 2) and 603,884 initiated weak opioids (Cohort 3). Overall, 1.4% of people escalated to doses ≥50mg OMEs/day, 0.8% to doses ≥90mg OMEs/day, and 7.3% transitioned to strong opioids. The strongest predictors of transitioning included prior treatment for cancer (Cohort 1:HR=3.19, 95%CI 3.00-3.40; Cohort 2:HR=4.19, 95%CI 3.90-4.51; Cohort 3:HR=2.07, 95%CI 1.95-2.18) and age ≥75 years (Cohort 1:HR=3.04, 95%CI 2.73-3.38, Cohort 2:HR=2.51, 95%CI 2.17-2.89; Cohort 3:HR=1.88, 95%CI 1.80-1.96). Females transitioned to high doses and strong opioids less rapidly than males (Cohort 1:HR=0.79, 95%CI 0.76-0.82; Cohort 2:HR=0.70, 95%CI 0.66-0.73; Cohort 3:HR=0.95, 95%CI 0.93-0.96) CONCLUSIONS: In Australia, more than one in every 13 people initiating weak opioids transition to strong opioids. By extrapolation, more than 26,000 Australian adults initiating opioids escalate to high doses each year. People with cancer treatment history, older people and males transition to strong and high-dose opioids more rapidly than others.

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过渡到高剂量或强阿片类药物：一项基于人群的澳大利亚阿片类药物起始研究

背景和目的 强效和高剂量阿片类药物与阿片类药物过量和死亡有关。本研究的目的是确定开始使用阿片类药物的人过渡到高剂量或强阿片类药物的比率和预测因素。设计 回顾性队列研究。设置澳大利亚。参与者 从 2013 年 7 月至 2018 年 1 月开始使用阿片类镇痛药的人是从澳大利亚药物福利计划合格人群的随机 10% 样本中确定的。测量危险比 (HRs) 和 95% 置信区间 (CIs) 被估计为升级至≥50 mg 口服吗啡当量 (OMEs)/天的预测因子（队列 1）；≥90 mg OMEs/天（队列 2）并在 12 个月的随访期间从弱阿片类药物过渡到强阿片类药物（队列 3）。预测因素包括年龄、性别、合并症数量、抑郁症病史，癌症的既往治疗，以及选择的其他药物使用。结果 总共有 861,691 人以 <50mg OMEs/天的平均剂量开始使用阿片类药物（队列 1），874,401 人以 <90mg OMEs/天（队列 2）和 603,884 人开始使用弱阿片类药物（队列 3）。总体而言，1.4% 的人升级到剂量≥50mg OMEs/天，0.8% 的人升级到剂量≥90mg OMEs/天，7.3% 过渡到强阿片类药物。转变的最强预测因子包括癌症的既往治疗（队列 1：HR=3.19，95%CI 3.00-3.40；队列 2：HR=4.19，95%CI 3.90-4.51；队列 3：HR=2.07，95%CI 1.95 -2.18) 且年龄 ≥75 岁（队列 1：HR=3.04，95%CI 2.73-3.38，队列 2：HR=2.51，95%CI 2.17-2.89；队列 3：HR=1.88，95%CI 1.960-1 ）。女性过渡到高剂量和强阿片类药物的速度比男性慢（队列 1：HR=0.79，95%CI 0.76-0.82；队列 2：HR=0.70，95%CI 0.66-0.73；队列 3：HR=0.95，95% CI 0.93-0.96) 结论：在澳大利亚，每 13 个人中就有超过一个开始使用弱阿片类药物过渡到强阿片类药物。通过推断，每年有超过 26,000 名开始使用阿片类药物的澳大利亚成年人升级为高剂量。有癌症治疗史的人、老年人和男性比其他人更快地过渡到强效和高剂量的阿片类药物。