The COVID-19 pandemic disrupted health-care delivery, including difficulty accessing in-person care, which could have increased the need for strong pharmacological pain relief. Due to the risks associated with overprescribing of opioids, especially to vulnerable populations, we aimed to quantify changes to measures during the COVID-19 pandemic, overall, and by key subgroups. For this interrupted time-series analysis study conducted in England, with National Health Service England approval, we used routine clinical data from more than 20 million general practice adult patients in OpenSAFELY-TPP, which is a a secure software platform for analysis of electronic health records. We included all adults registered with a primary care practice using TPP-SystmOne software. Using interrupted time-series analysis, we quantified prevalent and new opioid prescribing before the COVID-19 pandemic (January, 2018–February, 2020), during the lockdown (March, 2020–March, 2021), and recovery periods (April, 2021–June, 2022), overall and stratified by demographics (age, sex, deprivation, ethnicity, and geographical region) and in people in care homes identified via an address-matching algorithm. There was little change in prevalent prescribing during the pandemic, except for a temporary increase in March, 2020. We observed a 9·8% (95% CI –14·5 to –6·5) reduction in new opioid prescribing from March, 2020, with a levelling of the downward trend, and rebounding slightly after April, 2021 (4·1%, 95% CI –0·9 to 9·4). Opioid prescribing rates varied by demographics, but we found a reduction in new prescribing for all subgroups except people aged 80 years or older. Among care home residents, in April, 2020, parenteral opioid prescribing increased by 186·3% (153·1 to 223·9). Opioid prescribing increased temporarily among older people and care home residents, likely reflecting use to treat end-of-life COVID-19 symptoms. Despite vulnerable populations being more affected by health-care disruptions, disparities in opioid prescribing by most demographic subgroups did not widen during the pandemic. Further research is needed to understand what is driving the changes in new opioid prescribing and its relation to changes to health-care provision during the pandemic. The Wellcome Trust, Medical Research Council, The National Institute for Health and Care Research, UK Research and Innovation, and Health Data Research UK.

中文翻译：

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英国 COVID-19 大流行期间阿片类药物处方的变化：OpenSAFELY-TPP 队列的中断时间序列分析


COVID-19 大流行扰乱了医疗保健服务，包括难以获得面对面护理，这可能增加了对强效药物止痛的需求。由于过度处方阿片类药物所带来的风险，尤其是对弱势群体而言，我们的目的是量化 COVID-19 大流行期间整体和关键亚组的措施变化。对于这项在英格兰进行的中断时间序列分析研究，经英格兰国家卫生服务局批准，我们使用了 OpenSAFELY-TPP 中超过 2000 万全科成人患者的常规临床数据，这是一个用于分析电子健康记录的安全软件平台。我们纳入了使用 TPP-SystmOne 软件在初级保健诊所注册的所有成年人。使用间断时间序列分析，我们量化了 COVID-19 大流行之前（2018 年 1 月至 2020 年 2 月）、封锁期间（2020 年 3 月至 2021 年 3 月）和恢复期（2021 年 4 月）的流行和新阿片类药物处方– 2022 年 6 月），总体上按人口统计数据（年龄、性别、贫困、种族和地理区域）以及通过地址匹配算法识别的护理院中的人员进行分层。除 2020 年 3 月暂时增加外，大流行期间流行的处方几乎没有变化。我们观察到，自 3 月份以来，新阿片类药物处方减少了 9·8%（95% CI –14·5 至 –6·5）。 2020 年，下降趋势趋于平稳，2021 年 4 月后略有反弹（4·1%，95% CI –0·9 至 9·4）。阿片类药物处方率因人口统计数据而异，但我们发现除 80 岁或以上人群外，所有亚组的新处方均有所减少。在疗养院居民中，2020 年 4 月，肠外阿片类药物处方增加了 186·3%（153·1 至 223·9）。 阿片类药物处方在老年人和疗养院居民中暂时增加，可能反映出用于治疗临终 COVID-19 症状。尽管弱势群体受到医疗保健中断的影响更大，但大多数人口亚群体在阿片类药物处方方面的差异在大流行期间并未扩大。需要进一步研究来了解是什么推动了新阿片类药物处方的变化及其与大流行期间医疗保健供应变化的关系。威康信托基金会、医学研究委员会、国家健康与护理研究所、英国研究与创新以及英国健康数据研究中心。