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Pharmacotherapy. 2019 Jan 13. doi: 10.1002/phar.2218. [Epub ahead of print]

Potentially Unsafe Chronic Medication Use among Older Adult Chronic Opioid Users.

Author information

1
Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University Colleges of Pharmacy, Columbus, Ohio.
2
Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University Colleges of Pharmac Medicine, Columbus, Ohio.

Abstract

STUDY OBJECTIVES:

To assess chronic potentially unsafe medication use among older adults using opioids chronically versus those who did not, to assess the likelihood of chronically using medications to treat adverse effects associated with chronic opioid use, and to characterize the differences in chronic potentially unsafe medication use at three morphine equivalent dose (MED) levels/day (<50MED, 50-90MED, and >90MED).

DESIGN:

Retrospective cross-sectional analysis.

DATA SOURCE:

Prescription claims data from a national telehealth Medication Therapy Management (MTM) provider for the year 2015.

PATIENTS:

All Medicare Part D beneficiaries (≥ 65 years old [older adults]) from one Medicare Part D plan provider in one state who were eligible to receive MTM services.

MEASUREMENTS AND MAIN RESULTS:

Medication claims were limited to refills in a 120-day window from one Medicare Part D provider. Chronic medication use was defined as having a total days' medication supply of 84 days or more. χ2 tests and odds ratios (ORs) were used to compare chronic medication use among beneficiaries who were chronic opioid users versus non-opioid users. Analyses were repeated among chronic opioid users at the <50MED, 50-90MED, and >90MED levels. Unpaired t tests and Welch's analysis of variance paired with Games-Howell post hoc tests were used for continuous variables. Older adult (mean age 76 years) chronic opioid users were more likely to chronically use muscle relaxants (OR 2.67, 95% CI 2.20-3.25), benzodiazepines (OR 2.08, 95% CI 1.87-2.31), hypnotics (OR 1.98, 95% CI 1.67-2.34), antidepressants (OR 1.64, 95% CI 1.51-1.77), and nonsteroidal antiinflammatory drugs (OR 1.78, 95% CI 1.59-1.98) versus non-opioid users. Further, chronic opioid users were 3.04 (95% CI 2.05-4.51) times more likely to use muscle relaxants and benzodiazepines concomitantly chronically and also more likely to use medications chronically to treat gastrointestinal reflux disease, constipation, estrogen loss, nausea and vomiting, and edema. Very high-dose (>90MED/day) chronic opioid users were more likely than low-dose users (<50MEDs) to use antidepressants (OR 1.51, 95% CI 1.15-1.97, p=0.003).

CONCLUSION:

Older adults with chronic opioid use were more likely to chronically use potentially unsafe medications. These data demonstrated discordance between national prescribing guidelines and real-world practice among older adults with chronic pain in one Medicare Part D plan. This article is protected by copyright. All rights reserved.

KEYWORDS:

Beers’ List; Medicare; Mental Health; Older Adult; Opioid

PMID:
30636335
DOI:
10.1002/phar.2218

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