Dataset Information

Use and Opinions of Prescription Opioids Among Older American Adults: Sociodemographic Predictors.

ABSTRACT: OBJECTIVES:This study identifies sociodemographic predictors of prescription opioid use among older adults (age 65+) during the peak decade of U.S. opioid prescription, and tests whether pain level and Medicaid coverage mediate the association between low wealth and opioid use. Predictors of prescription nonsteroidal anti-inflammatory drug (NSAID) use, and of opinions of both drug classes, are also examined. METHOD:Regressions of opioid and NSAID use on sociodemographic characteristics, pain level, and insurance type were conducted using Health and Retirement Study 2004 core and 2005 Prescription Drug Study data (n = 3,721). Mediation analyses were conducted, and user opinions of drug importance, quality, and side effects were assessed. RESULTS:Low wealth was a strong, consistent predictor of opioid use. Both pain level and Medicaid coverage significantly, but only partially, mediated this association. Net of wealth, there were no significant associations between education and use of, or opinions of, either class of drugs. DISCUSSION:Among older American adults, the poorest are disproportionately likely to have been exposed to prescription opioid analgesics. Wealth, rather than education, drove social class differences in mid-2000s opioid use. Opioid-related policies should take into account socioeconomic contributors to opioid use, and the needs and treatment histories of chronic pain patients.

SUBMITTER: Grol-Prokopczyk H

PROVIDER: S-EPMC6941497 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Use and Opinions of Prescription Opioids Among Older American Adults: Sociodemographic Predictors.

Grol-Prokopczyk Hanna H

The journals of gerontology. Series B, Psychological sciences and social sciences 20190801 6

<h4>Objectives</h4>This study identifies sociodemographic predictors of prescription opioid use among older adults (age 65+) during the peak decade of U.S. opioid prescription, and tests whether pain level and Medicaid coverage mediate the association between low wealth and opioid use. Predictors of prescription nonsteroidal anti-inflammatory drug (NSAID) use, and of opinions of both drug classes, are also examined.<h4>Method</h4>Regressions of opioid and NSAID use on sociodemographic characteri ...[more]

PMID: 30107532

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Project description:BackgroundOpioid use has increased globally in the recent decade. Although pain remains a significant problem among older adults, susceptibility to opioid-related harms highlights the importance of careful opioid therapy monitoring on individual and societal levels. We aimed to describe the trends of prescription opioid utilisation among residents aged ≥65 in all Nordic countries during 2009-2018.MethodsWe conducted cross-sectional measurements of opioid utilisation in 2009-2018 from nationwide registers of dispensed drugs in Denmark, Finland, Iceland, Norway, and Sweden. The measures included annual opioid prevalence, defined daily doses (DDDs) per 1000 inhabitants per day (DIDs), and morphine milligram equivalents (MMEs) per user per day.ResultsFrom 2009 to 2018, an average of 808,584 of adults aged ≥65 used opioids yearly in all five countries; an average annual prevalence of 17.0%. During this time period, the prevalence decreased in Denmark, Norway, and Sweden due to declining codeine and/or tramadol use. Iceland had the highest opioid prevalence in 2009 (30.2%), increasing to 31.7% in 2018. In the same period, DIDs decreased in all five countries, and ranged from 28.3 in Finland to 58.5 in Denmark in 2009, and from 23.0 in Finland to 54.6 in Iceland in 2018. MMEs/user/day ranged from 4.4 in Iceland to 19.6 in Denmark in 2009, and from 4.6 in Iceland to 18.8 in Denmark in 2018. In Finland, Norway, and Sweden, MMEs/user/day increased from 2009 to 2018, mainly due to increasing oxycodone utilisation.ConclusionsThe stable or decreasing opioid utilisation prevalence among a majority of older adults across the Nordic countries coincides with an increase in treatment intensity in 2009-2018. We found large cross-national differences despite similarities across the countries' cultures and healthcare systems. For the aged population, national efforts should be placed on improving pain management and monitoring future trends of especially oxycodone utilisation.

Project description:BackgroundLong-term opioid use is a known risk factor for opioid-related harms. We aimed to identify risk factors for and predictors of long-term use of prescription opioids in the community-dwelling population of adults without a diagnosis of cancer, to inform practice change at the point of care.MethodsUsing Quebec administrative claims databases, we conducted a retrospective cohort study in a random sample of adult members (≥ 18 yr) of the public drug plan who did not have a cancer diagnosis and who initiated a prescription opioid in the outpatient setting between Jan. 1, 2012, and Dec. 31, 2016. The outcome of interest was long-term opioid use (≥ 90 consecutive days or ≥ 120 cumulative days over 12 mo). Potential predictors included sociodemographic factors, medical history, characteristics of the initial opioid prescription and prescriber's specialty. We used multivariable logistic regression to assess the association between each characteristic and long-term use. We used the area under the receiver operating characteristic curve to determine the predictive performance of full and parsimonious models.ResultsOf 124 664 eligible patients who initiated opioid therapy, 4172 (3.3%) progressed to long-term use of prescription opioids. The most important associated factors in the adjusted analysis were long-term prescription of acetaminophen-codeine (odds ratio [OR] 6.30, 95% confidence interval [CI] 4.99 to 7.96), prescription of a long-acting opioid at initiation (OR 6.02, 95% CI 5.31 to 6.84), initial supply of 30 days or more (OR 4.22, 95% CI 3.81 to 4.69), chronic pain (OR 2.41, 95% CI 2.16 to 2.69) and initial dose of at least 90 morphine milligram equivalents (MME) per day (OR 1.24, 95% CI 1.04 to 1.47). Our predictive model, including only the initial days' supply and chronic pain diagnosis, had area under the curve of 0.7618.InterpretationThis study identified factors associated with long-term prescription opioid use. Limiting the initial supply to no more than 7 days and limiting doses to 90 MME/day or less are actions that could be undertaken at the point of care.

Dataset Information

Use and Opinions of Prescription Opioids Among Older American Adults: Sociodemographic Predictors.

Publications

Use and Opinions of Prescription Opioids Among Older American Adults: Sociodemographic Predictors.

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