Long-term opioid therapy in older adults: Incidence and risk factors related to patient characteristics and initial opioid dispensed.

Background: The clinical benefits of long-term opioid therapy (LTOT) are not clearly known; however, LTOT is associated with various adverse outcomes.

Objective: This study aimed to estimate the incidence and risk factors associated with LTOT in adults aged ≥ 65 years.

Methods: This was a retrospective cohort study using Medicare claims data. Opioid-naïve older adults filling an opioid prescription between 2014 and 2016 were included. The outcome variable was LTOT, defined as an opioid use episode longer than 90 days and having > 60 cumulative days of supply. Predictor variables included patient characteristics, characteristics of initial opioid dispensed, and pain conditions. Multivariable logistic regression was performed to assess the association between predictors and LTOT.

Results: Among 162,287 participants, 10,296 (6.3%) met the definition of LTOT. Key patient characteristics associated with LTOT were age > 85 years (adjusted odds ratio 1.13 [95% confidence interval 1.05-1.21]); > 5 comorbidities (1.55 [1.45-1.65]); and history of drug use disorder (1.53 [1.35-1.74]), alcohol use disorder (1.38 [1.23-1.54]), tobacco use disorder (1.31 [1.23-1.40]), and opioid use disorder (2.00 [1.69-2.37]). Characteristics of initial opioid associated with LTOT were dispensing long-acting opioids (1.72 [1.21-2.44]) and concomitant use of benzodiazepines (1.16 [1.08-1.25]), gabapentinoids (1.57 [1.47-1.67]), and prescription nonsteroidal anti-inflammatory drugs (1.24 [1.17-1.31]). Anxiety disorders were associated with 1.4-1.5 times increased odds of LTOT. Moreover, initial opioid supply of ≥ 30 days led to 11-16 times higher odds of LTOT than days' supply of 1-3 days.

Conclusions: Factors related to patient characteristics (age, number of comorbidities, substance use disorders, anxiety disorders) and initial opioid dispensation (duration of action, certain concomitant medications, days' supply) are associated with LTOT in older adults. Prescribers should consider these factors when prescribing opioids to senior patients.