Predictors of persistent prescription opioid analgesic use among people without cancer in Australia

Lalic, Samanta; Gisev, Natasa; Bell, Jane; Korhonen, Maarit Jaana; Ilomäki, Jenni

doi:10.1111/bcp.13556

Cited by 58 publications

(73 citation statements)

References 51 publications

(93 reference statements)

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“…Also, by using medications as a surrogate to identify persons with comorbidities, people on non‐pharmacological approaches for managing their condition may have been missed. Regardless, the Rx‐Risk‐V tool that was used in identifying comorbidities has been validated and widely used by Australian and international researchers to ascertain the presence of chronic morbidities . We were also unable to stratify our results according to statin indication and future studies should examine predictors specifically for people being prescribed statins for primary and secondary prevention.…”

Section: Discussionmentioning

confidence: 98%

Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Ofori‐Asenso

Ilomäki

Tacey

et al. 2018

Brit J Clinical Pharma

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Aims The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. Methods Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first‐year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co‐payment; n = 4841) and concessional beneficiaries (with a lower co‐payment; n = 17 499). Results During the one‐year follow‐up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75–84 years and ≥85 years were more likely to discontinue than people aged 65–74 years (odds ratio 1.11, 95% confidence interval 1.04–1.19 and 1.38, 1.23–1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. Conclusions Among older adults prescribed statins, first‐year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.

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Section: Discussionmentioning

confidence: 98%

Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Ofori‐Asenso

Ilomäki

Tacey

et al. 2018

Brit J Clinical Pharma

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“…Comorbidities were determined using the validated RxRisk‐V tool, which uses records of dispensed medications to identify probable medical conditions . A full list of medications and their respective medical conditions is reported elsewhere . A look‐back period of 12 months from the date of opioid initiation was used to establish probable comorbidities.…”

Section: Methodsmentioning

confidence: 99%

“…Previous Australian research has indicated that the RxRisk‐V tool identifies fewer people with cancer compared to the Charlson's Comorbidity Index (43.2 versus 67.2%), which is widely used and considered a ‘gold standard’ approach to assess disease burden . For this reason we used a more comprehensive medication‐based indicator of cancer treatment that included other anti‐neoplastic therapies such as hormonal cancer therapies . Cancer treatment history was used as a predictor because cancer‐related pain could influence the rate of opioid transitions.…”

Section: Methodsmentioning

confidence: 99%

“…The incidence of opioid use slightly declined from 2013 to 2017 in Australia, but initiation of strong opioids increased during this period . Of the 1.9 million adults who initiate opioids each year in Australia , nearly 50 000 will become persistent users . It is unclear how many of these people escalate to high doses or transition to strong opioids.…”

Section: Introductionmentioning

confidence: 99%

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Transition to high‐dose or strong opioids: a population‐based study of people initiating opioids in Australia

et al. 2020

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Background and aims Strong and high-dose opioids are associated with opioid overdose and death. The objective of this study was to determine the rate and predictors of transitioning to high-dose or strong opioids among people initiating opioids. Design Retrospective cohort study. Setting Australia. Participants People initiating opioid analgesics from July 2013 to January 2018 were identified from a random 10% sample of Australia's Pharmaceutical Benefits Scheme eligible population. Measurements Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the predictors of escalating to ≥ 50 mg oral morphine equivalents (OMEs)/day (cohort 1); ≥ 90 mg OMEs/day (cohort 2) and transitioning from weak opioids to strong opioids (cohort 3) over 12 months of follow-up. Predictors included age, sex, number of comorbidities, history of depression, prior treatment for cancer and selected other medication use. Findings In total, 861 691 people initiated opioids at average doses < 50 mg OMEs/day (cohort 1), 874 401 at < 90 mg OMEs/day (cohort 2) and 603 884 initiated weak opioids (cohort 3). Overall, 1.4% of people escalated to doses ≥ 50 mg OMEs/day, 0.8% to doses ≥ 90 mg OMEs/day and 7.3% transitioned to strong opioids. The strongest predictors of transitioning included prior treatment for cancer [cohort 1: HR = 3.19, 95% CI = 3.00-3.40; cohort 2: HR = 4.19, 95% CI = 3.90-4.51; cohort 3: HR = 2.07, 95% CI = 1.95-2.18] and age ≥ 75 years (cohort 1: HR = 3.04, 95% CI = 2.73-3.38; cohort 2: HR = 2.51, 95% CI = 2.17-2.89; cohort 3: HR = 1.88, 95% CI = 1.80-1.96). Females transitioned to high doses and strong opioids less rapidly than males (cohort 1: HR = 0.79, 95% CI = 0.76-0.82; cohort 2: HR = 0.70, 95% CI = 0.66-0.73; cohort 3: HR = 0.95, 95% CI = 0.93-0.96). Conclusions In Australia, more than one in every 13 people initiating weak opioids transition to strong opioids. By extrapolation, more than 26 000 Australian adults initiating opioids escalate to high doses each year. People with cancer treatment history, older people and males transition to strong and high-dose opioids more rapidly than others.

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“…Little is known about the development of chronic opioid prescription in older adults. One recent study of older Australians without malignancy found that people aged 75 years or more who were prescribed opioids were 2.5 times more likely to persist with long‐term opioid use than those aged 18‐44 years . A prior history of depression, use of non‐opioid analgesics and prescriber choice of initial opioids (transdermal formulation and high oral morphine equivalent) were all associated with long‐term opioid use in older Australians .…”

mentioning

confidence: 99%

The use of opioids for chronic non‐cancer pain in older Australians

O'Brien¹,

Wand

Draper

2019

Australas J Ageing

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Predictors of persistent prescription opioid analgesic use among people without cancer in Australia

Cited by 58 publications

References 51 publications

Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Transition to high‐dose or strong opioids: a population‐based study of people initiating opioids in Australia

The use of opioids for chronic non‐cancer pain in older Australians

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