Long-Term Opioid Therapy in Older Adults: Incidence and Risk Factors Related to Patient Characteristics and Initial Opioid Dispensed

Iftekhar Ahmed; Alan J Zillich; Noll L Campbell; Kevin M Sowinski; David R Foster

doi:10.1016/j.japh.2024.102311

Long-Term Opioid Therapy in Older Adults: Incidence and Risk Factors Related to Patient Characteristics and Initial Opioid Dispensed

J Am Pharm Assoc (2003). 2024 Dec 10:102311. doi: 10.1016/j.japh.2024.102311. Online ahead of print.

Authors

Iftekhar Ahmed¹, Alan J Zillich², Noll L Campbell³, Kevin M Sowinski², David R Foster⁴

Affiliations

¹ Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis and West Lafayette, IN.
² Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis and West Lafayette, IN; Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN.
³ Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis and West Lafayette, IN; Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN; Indiana University Center for Aging Research, Regenstrief Institute Inc., Indianapolis, IN.
⁴ Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis and West Lafayette, IN; Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN. Electronic address: drfoster@purdue.edu.

PMID: 39667526
DOI: 10.1016/j.japh.2024.102311

Abstract

Background: The clinical benefits of long-term opioid therapy (LTOT) are not clearly known, however, LTOT is associated with various adverse outcomes.

Objective: Estimate the incidence and risk factors associated with LTOT in adults aged ≥ 65 years.

Methods: This was a retrospective cohort study using Medicare claims data. Opioid naïve older adults filling an opioid prescription between 2014-2016 were included. The outcome variable was LTOT, defined as an opioid use episode longer than 90 days and having ≥60 cumulative days of supply. Predictor variables included patient characteristics, characteristics of initial opioid dispensed, and pain conditions. Multivariable logistic regression was performed to assess the association between predictors and LTOT.

Results: Among 162,287 participants, 10,296 (6.3%) met the definition of LTOT. Key patient characteristics associated with LTOT were age>85 years (adjusted odds ratio [AOR]: 1.13, 95% confidence interval [CI]: 1.05-1.21), >5 comorbidities (AOR: 1.55, 95% CI: 1.45-1.65); history of drug use disorder (AOR: 1.53, 95% CI: 1.35-1.74), alcohol use disorder (AOR: 1.38, 95% CI: 1.23-1.54), tobacco use disorder (AOR: 1.31, 95% CI: 1.23-1.40), and opioid use disorder (AOR: 2.00, 95% CI: 1.69-2.37). Characteristics of initial opioid associated with LTOT were dispensing long-acting opioids (AOR: 1.72, 95% CI: 1.21-2.44); concomitant use of benzodiazepines (AOR: 1.16, 95% CI: 1.08-1.25), gabapentinoids (AOR: 1.57, 95% CI: 1.47-1.67), and prescription non-steroidal anti-inflammatory drugs (AOR: 1.24, 95% CI: 1.17-1.31). Anxiety disorders were associated with 1.4-1.5 times increased odds of LTOT. Moreover, initial opioid supply of ≥ 30 days led to 11-16 times higher odds of LTOT compared to days' supply of 1-3 days.

Conclusions: Factors related to patient characteristics (age, number of comorbidities, substance use disorders, anxiety disorders) and initial opioid dispensation (duration of action, certain concomitant medications, days' supply) are associated with LTOT in older adults. Prescribers should consider these factors when prescribing opioids to elderly patients.

Keywords: Long-term opioid therapy; Older adults; Opioid; Risk factors.