Patterns and predictors of opioid use in older adults with chronic non-cancer pain

Abstract

Background: Opioid use has increased globally which resulted in a dramatic rise in opioid overdose, abuse and mortality. Limited research is available on the patterns and predictors of opioid use in older adults in New Zealand and internationally. Aim: To investigate the incidence and prevalence of opioid use in general older adults. Additionally, the rate and predictors of persistent opioid use in older adults without cancer diagnosis were examined. Methods: This was a population-based retrospective cohort study. This was a population-based retrospective cohort study conducted using national administrative healthcare databases. The annual opioid use incidence (2008-2018) and prevalence (2007-2018) in older adults were determined and stratified by sex and opioid type. The rate and predictors of persistent opioid use among older adults without cancer diagnosis from 2013-2018 were also determined. Persistent opioid use is defined as having filled ≥1 opioid prescription in the 91 to 180 days after index opioid prescription. Multivariable logistic regression models were used to identify predictors of persistent opioid use. SQL and SPSS software were used to link and analyse data, respectively. Results: A total of 820,349 older adults were initiated on opioids during the study period. The overall incidence of opioid use in older adults showed a steady increase from 2008-2015, similarly, the prevalence has steadily increased from 2007-2015, and then both rates fluctuated thereafter. A slight decrease was observed in 2018. Codeine and tramadol were the most commonly dispensed opioids during the study period. Females had higher incidence and prevalence for all opioids. Among 268,857 non-cancer older patients with ≥1 opioid dispensing between 2013-2018, 2.2% became persistent opioid users. The use of fentanyl, strong opioids, slow-release preparations, presence of ≥3 co-morbidities, and the use of anti-epileptics and non-opioid analgesics were the strongest predictors of persistent opioid use. Conclusions: The study findings showed an increase in opioid incidence and prevalence in older adults over time. A considerable number of older adults became persistent opioid users and a number of factors were found to contribute to persistent opioid use. Understanding predictors of persistent opioid use will enable prescribers and policy-makers to target early interventions to prevent future opioid-related adverse events.