Impact of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011-2015

Details

• Alternative Title:
  J Am Geriatr Soc
• Personal Author:
  Rose, Adam J. ; McBain, Ryan ; Schuler, Megan S. ; LaRochelle, Marc R. ; Ganz, David A. ; Kilambi, Vikram ; Stein, Bradley D. ; Bernson, Dana ; Chui, Kenneth Kwan Ho ; Land, Thomas ; Walley, Alexander Y. ; Stopka, Thomas J.
• Description:
  Background/Objectives:
  
  Potentially inappropriate opioid prescribing (PIP) may contribute to risk for fatal opioid overdose among older adults (age 50+). Our objective was to examine the effect of age on the likelihood of PIP exposure, as well as the effect of PIP exposure on adverse outcomes.
  
  Design:
  
  Retrospective cohort study
  
  Setting:
  
  Data from multiple state agencies in Massachusetts, 2011–2015
  
  Participants:
  
  Over 3 million adult Massachusetts residents (3,078,163) who received at least one prescription opioid during the study period; approximately half (1,589,365) were older adults (age 50+).
  
  Measurements:
  
  We measured exposure to five types of PIP: high-dose opioids, co-prescription with benzodiazepines, multiple opioid prescribers, multiple opioid pharmacies, and continuous opioid therapy without a pain diagnosis. We examined three adverse outcomes: non-fatal opioid overdose, fatal opioid overdose, and all-cause mortality.
  
  Results:
  
  The rate of any PIP exposure increased with age, ranging from 2% among individuals age 18–29 to 14% among those age 50 and older. Older adults also had elevated rates of exposure to two or more different types of PIP, including 5% of adults age 50–69 and 4% of adults age 70 or older, in comparison to 2.5% of age 40–49 and lower percentages in younger age groups. Among covariates assessed, increasing age was the greatest positive predictor of PIP exposure. In analyses stratified by age, exposure to both any PIP and specific types of PIP were associated with non-fatal overdose, fatal overdose, and all-cause mortality among both younger and older adults.
  
  Conclusion:
  
  Older adults are more likely to be exposed to PIP, which elevates their risk for adverse events. Strategies to reduce exposure to PIP, and to improve outcomes among those already exposed, will be instrumental to addressing the opioid crisis as it manifests among older adults.
  
  
• Subjects:
  Aged Aged, 80 And Over Age Factors Analgesics, Opioid Article Drug Overdose Female Humans Male Massachusetts Middle Aged Mortality Opioid-Related Disorders Opioid Overdose Pain Potentially Inappropriate Opioid Prescribing Practice Patterns, Physicians' Retrospective Studies

  More +
• Source:
  J Am Geriatr Soc. 67(1):128-132
• Pubmed ID:
  30471102
• Pubmed Central ID:
  PMC6448572
• Document Type:
  Journal Article
• Funding:
  K23 DA042168/DA/NIDA NIH HHS/United States ; P50 DA046351/DA/NIDA NIH HHS/United States ; U01 CE002780/CE/NCIPC CDC HHS/United States ; UL1 TR001430/TR/NCATS NIH HHS/United States
• Volume:
  67
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:38b155bb3fd3ef2e47522657ab41a9cf07602a69c061e41b56e252a61d5898f6
• Download URL:
  https://stacks.cdc.gov/view/cdc/101061/cdc_101061_DS1.pdf
• File Type:
  [PDF - 254.04 KB ]