这项工作的目的是通过患者、入院和临床特征来描述澳大利亚新南威尔士州急诊科 (ED) 就诊或住院后阿片类药物的起始使用和长期使用。这是一项基于人群的队列研究，包括所有2014 年至 2020 年间，上一年未配发阿片类药物的成年人的住院和急诊就诊次数，与药物配发、死亡和癌症登记（药物情报数据平台）相关。结果指标为阿片类药物的初始使用（出院后 7 天内配药）和长期使用（连续暴露 90 天，开始后 90-270 天）。该队列包括 420 万未使用过阿片类药物的成人中的 16-153-096 名入院患者； 39.0% 是在急诊室就诊但未入院，16.8% 通过急诊室入院，44.2% 直接入院。 6.2% 的急诊患者、8.3% 的经急诊住院患者和 10.0% 的直接入院患者在出院后开始使用阿片类药物；其中 1.0%、2.5% 和 0.5% 分别发展为长期使用阿片类药物。未进行手术的产科入院启动率最低（1.0%），创伤入院（25.4%）、接受手术干预的产科入院（19.8%）和非创伤手术入院（12.0%）启动率最高。经急诊入院 (3.5%)、创伤入院 (2.3%) 和单独急诊入院 (1.0%) 的长期使用率最高。从 2014 年到 2020 年，阿片类药物总体使用量下降了 16%，从 8.7% 下降到 7.2%，长期使用阿片类药物使用量下降了 33%，从 1.3% 下降到 0.8%。阿片类药物使用量和长期使用量都随着时间的推移而减少；然而，创伤后长期使用以及通过急诊室入院的比例较高，需要进一步监测。支持适当处方和获得多学科疼痛服务的策略将促进最佳实践护理。© 2024 作者。约翰·威利出版的《英国临床药理学杂志》

The aim of this work is to describe opioid initiation and long-term use after emergency department (ED) visits or hospitalizations in New South Wales, Australia, by patient, admission and clinical characteristics.This is a population-based cohort study, including all hospitalizations and ED visits between 2014 and 2020, linked to medicine dispensings, deaths and cancer registrations (Medicines Intelligence Data Platform), among adults with no opioid dispensings in the previous year. Outcome measures were opioid initiations (dispensed within 7 days of discharge) and long-term use (90 days of continuous exposure, 90-270 days after initiation).The cohort included 16 153 096 admissions by 4.2 million opioid-naïve adults; 39.0% were ED presentations without hospital admission, 16.8% hospital admissions via ED and 44.2% direct hospital admissions. Opioids were initiated post-discharge for 6.2% of ED, 8.3% of hospital via ED and 10.0% of direct hospital admissions; of these 1.0%, 2.5% and 0.5% progressed to long-term opioid use, respectively. Initiation was lowest in obstetric admissions without surgery (1.0%), and highest among trauma admissions (25.4%), obstetric admissions with surgical intervention (19.8%) and non-trauma surgical admissions (12.0%). Long-term use was highest among medical admissions via ED (3.5%), trauma admissions (2.3%) and ED alone (1.0%). From 2014 to 2020, overall opioid initiations decreased 16% from 8.7% to 7.2%, and long-term opioid use decreased 33% from 1.3% to 0.8%.Both opioid initiation and long-term use decreased over time; however, the higher rates of long-term use following trauma, and medical admissions via ED, warrant further surveillance. Strategies supporting appropriate prescribing and access to multidisciplinary pain services will facilitate best practice care.© 2024 The Author(s). British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.