老年人长期阿片类药物治疗:与患者特征和初始阿片类药物分配相关的发病率和风险因素。

IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Journal of the American Pharmacists Association Pub Date : 2024-12-10 DOI:10.1016/j.japh.2024.102311
Iftekhar Ahmed, Alan J Zillich, Noll L Campbell, Kevin M Sowinski, David R Foster
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Long-Term Opioid Therapy in Older Adults: Incidence and Risk Factors Related to Patient Characteristics and Initial Opioid Dispensed.

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.

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来源期刊
CiteScore
3.30
自引率
14.30%
发文量
336
审稿时长
46 days
期刊介绍: The Journal of the American Pharmacists Association is the official peer-reviewed journal of the American Pharmacists Association (APhA), providing information on pharmaceutical care, drug therapy, diseases and other health issues, trends in pharmacy practice and therapeutics, informed opinion, and original research. JAPhA publishes original research, reviews, experiences, and opinion articles that link science to contemporary pharmacy practice to improve patient care.
期刊最新文献
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