SA32 Continuity of Opioid Prescribing Among Older Adults on Long-Term Opioids

Ramachandran, Sujith; Salkar, Monika; Bhattacharya, K; Bentley, J.P.; Maharjan, S; Eriator, Ike; McGwin, G.; Mauney, MJ; Yang, Yi

doi:10.1016/j.jval.2022.04.1698

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“…In addition, average opioid daily dose during baseline hazard period was also included as covariate in the model. These covariates were included in the study, based on previous literature, as they might influence the relationship between opioid tapering velocity and the occurrence of MHC events 15,22–24 …”

Section: Methodsmentioning

confidence: 99%

Opioid tapering and mental health crisis in older adults

Maharjan,

Ramachandran,

Bhattacharya

et al. 2023

Pharmacoepidemiology and Drug

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BackgroundOpioid tapering and discontinuation have increased in recent years with the implementation of national prescribing guidelines. This study aimed to examine the relationship between opioid tapering velocity and mental health crisis events in older Medicare beneficiaries.MethodsA nested case–control study was conducted using the 2012–2018, 5% national Medicare claims data. Older adults with chronic non‐cancer pain (CNCP) who were receiving long‐term opioid therapy (LTOT) were included in the study. Cases were defined as individuals experiencing mental health crisis events; controls were identified using incidence density sampling. The opioid tapering velocity was measured in the 120‐day hazard period that yielded a monthly percentage of dose change. Conditional logistic regression was used to assess the relationship of interest.ResultsA total of 42 091 older adults with CNCP were eligible for the study. Cases (n = 952) were matched with controls in a 1:2 ratio based on age (±1 year) and time of cohort entry (±30 days). A higher percentage of controls (67.65%) were on steady dose compared with cases (59.03%). In the adjusted model, tapering (aOR = 1.36; 95% CI: 1.02–1.83), rapid tapering (aOR = 1.45; 95% CI: 1.11–1.91), and dose escalation (aOR = 1.78; 95% CI: 1.32–2.39) were significantly associated with the mental health crisis, compared with steady dose.ConclusionBoth opioid tapering and dose escalation are associated with mental health crisis events. Patient‐driven and gradual dose tapering, as recommended by prescribing guidelines, should be promoted to prevent mental health crisis events among older adults on LTOT.

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Section: Methodsmentioning

confidence: 99%