(B-117) Initial opioid prescriptions for non-cancer patients in Yinzhou China: a retrospective, observational study based on regional medical data during 2011-2023

Background: Despite the ongoing opioid epidemic in North America, China is reported to have lower utilization of opioid drugs due to the policies and cautious attitude. Little is known about the characteristics of initial opioid prescription and time trends in China.

Objectives: To describe the prescription patterns and annual trends of opioid among non-cancer patients in Yinzhou District, Ningbo, China during 2011-2023.

Methods: A retrospective, observational study was conducted based on the Ningbo Yinzhou District Universal Health Information Platform. Patients aged 18-100 with at least one opioid prescription in local medical institutions' services during 2011-2023 were included. Initial users were defined as patients without any history of opioid use in the past 2 years prior to first prescription. The effective doses of all opioid prescriptions were converted to Oral Morphine Equivalent (OME). High daily dose prescriptions was defined as OME ≥90 mg/day. Long-term opioid use was defined as continuous use ≥90 days, or cumulative use ≥120 day, or ≥10 prescriptions within a year. Subgroup analyses were conducted by sex, age, and ingredients.

Results: We identified 255,727 new opioid users in Yinzhou District during 2011-2023, with a prescription rate of 230.5 per thousand population (PTP). The mean age was 48.6 years for new opioid users, and 51.6% were women. The average prescription duration was 5.9 days, with a daily OME of 20.8 mg/day. Over half prescriptions were delivered in 3A hospitals (51.6%), department of surgery (39.0%) and general practice (28.4%). The most used opioids were codeine (52.6%), dezocine (23.1%), and tramadol (14.8%). Over a 13-year period, the opioid prescription rate peaked at 2012, with a prescription rate of 579.3 PTP, then decreased gradually to 134.0 PTP at 2023. Codeine use decreased 5-fold from 256.3 to 451 prescriptions PTP during 2011-2023, while the utilization of dezocine and tramadol increased sharply.
A total of 15,790 (6.2%) new users had a daily dose OME exceeding 90 mg. The highest proportion of new opioid users for high daily opioid dose were those aged 45-55 years (24.8%), followed by those aged 35-45 (19.1%) and 55-65 (19.1%), while men accounted for 57.7% high dose users. During 2011-2023, the high-dose rate of opioid prescriptions increased from 2011 (3.2 PTP) to 2016 (28.4 PTP), and plateaued for the following 5 years, then decreased to 3.7 PTP at 2023. A total of 86 patients experienced long-term opioid use, accounting for 0.03%.

Conclusions: The prescription rate of opioids in Yinzhou District decreased gradually during 2012-2023. The average prescription duration, and daily dose are lower than developed countries, but there is still a proportion of high-dose prescription and long-term opioid use.