Concurrent Use of Prescription Opioids and Gabapentinoids in Older Adults

Abstract Objectives Alcohol and medication use are increasingly prevalent in the older population. Concurrent use of alcohol and alcohol-interactive (AI) medication can lead to significant adverse consequences. Methods Three reference works were used to create an explicit list of drug substances for which information about the interaction with alcohol was available in at least one of them. Additional information was extracted from the Summary of Product Characteristics (SPC). The first aim was to generate a list of 256 substances with standardized advice regarding the concurrent use of each drug with alcohol. The second aim was to observe the prevalence of potential drug–alcohol-interactions. The list was applied to a database containing information about alcohol and medication use of 1,016 community-dwelling older patients (≥70 years) with polypharmacy. Results About half of the sample population reported to consume alcohol at least once a week. Around 22% were classified as frequent drinkers (5–7 days/week) and 11% as heavier drinkers (>7 units/week). Ninety-three percent alcohol consumers in our sample took at least one chronic drug that potentially interacts with alcohol and 42% used at least one chronic drug for which alcohol use is considered contraindicated. Conclusions We developed an explicit list of potentially drug–alcohol-interactions in older adults, with standardized handling advice. We observed that prevalence of potential drug–alcohol-interactions is substantial in community-dwelling older patients with polypharmacy.

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Prevalence of simultaneous use of alcohol and prescription medication in older adults: findings from a cross-sectional survey (Health Survey for England 2013)

BMJ Open ◽

10.1136/bmjopen-2018-023730 ◽

2019 ◽

Vol 9 (6) ◽

pp. e023730 ◽

Cited By ~ 2

Author(s):

John Foster ◽

Swatee Patel

Keyword(s):

Older Adults ◽

Health Survey ◽

Prescription Drugs ◽

Prescription Medication ◽

Well Being ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Related Factors ◽

Cross Sectional ◽

Concurrent Use

ObjectivesTo investigate the concurrent use of ‘at-risk’ (AR) drinking (>10 units of alcohol per week) and prescription medications, while controlling for sociodemographic, and health-related factors, among older adults (aged 65–89 years).DesignCross-sectional survey.SettingData from Health Survey of England, 2013.InterventionsNone.ParticipantsGeneral population survey of 2169 adults aged 65–89 years.Primary outcome measuresAR drinking (>10 units per week). Secondary outcome was AR drinking defined as >14 units of alcohol per week limit (the cut-off used by the Department of Health for AT drinking).ResultsTwenty-seven per cent (n=568) of the sample were AR drinkers. Factors associated with alcohol consumption were gender, age, social class, marital status, rurality of dwelling, deprivation index, self-reported general health, cigarette smoking, body mass index, exercise level, health and well-being scores’ and number of prescription drugs. Logistic regression analysis showed that males were more likely to be AR drinkers (OR 3.44, 95% CI 2.59 to 4.57, p<0.0001) than females. Each year increase in age, lowered the probability of AR drinking by a factor of 0.95 (95% CI 0.93 to 0.98, p<0.0001). Using prescription drugs reduced AR drinking by a factor of 0.92 (95% CI 0.85 to 0.93, p=0.033), after controlling for age, sex and rurality of dwelling. No other predictors were significant. Similar results were obtained for AR drinking of >14units per week.ConclusionAR drinking is more likely in older men than women. The odds of AR drinking lessens, as individuals age, and using prescription drugs also reduces AR drinking.

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Trends and Variations in Concurrent Dispensing of Prescription Opioids and Benzodiazepines in Australia: A Retrospective Analysis

Contemporary Drug Problems ◽

10.1177/0091450920919443 ◽

2020 ◽

Vol 47 (2) ◽

pp. 136-148

Author(s):

M. Mofizul Islam ◽

Dennis Wollersheim

Keyword(s):

Age Groups ◽

Population Level ◽

Prescription Opioids ◽

Defined Daily Dose ◽

Structural Factors ◽

Multilevel Regression ◽

Individual Level ◽

Adverse Health Outcomes ◽

Concurrent Use ◽

Yearly Average

Objective: Concurrent use of opioids and benzodiazepines may cause a range of adverse health outcomes including fatal overdose. However, little is known about levels of concurrent use and its variation across jurisdictions. This study examined the population-level prevalence of concurrent use in Australia. Methods: We analyzed a 10% sample of unit record data of prescription opioids and benzodiazepines dispensed between January 2013 and December 2016. Using dispensing dates and days of supply in terms of defined daily dose (DDD), the concurrent users were identified as those for whom the supply in DDD quantity for one medicine overlapped with the supply day of the other. Multivariable and multilevel regression models were developed. Results: During the 4 years, almost a million (12.41% of 7.96 million) individuals were identified as concurrent users. Significantly more women were concurrent users than men across all age groups. On average, 1,750 per 100,000 people were concurrent users per year. There was substantial variation in the yearly average of concurrent users across jurisdictions, ranging from less than 1 to 5,400 per 100,000 people (standardized). Much of this variation was attributed to individual-level circumstances rather than structural factors. Conclusion: Concurrent use of opioid and benzodiazepine was common in Australia. There was considerable variation across jurisdictions in terms of the number of concurrent users. Women, older people, or those living in socioeconomically disadvantaged areas were dominant groups of concurrent users. Further research is needed to examine the precise reasons for concurrent use.

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Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis

BMJ ◽

10.1136/bmj.j760 ◽

2017 ◽

pp. j760 ◽

Cited By ~ 186

Author(s):

Eric C Sun ◽

Anjali Dixit ◽

Keith Humphreys ◽

Beth D Darnall ◽

Laurence C Baker ◽

...

Keyword(s):

Retrospective Analysis ◽

Prescription Opioids ◽

Concurrent Use

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High-Risk Obtainment of Prescription Drugs by Older Adults in New Jersey: The Role of Prescription Opioids

Journal of the American Geriatrics Society ◽

10.1111/jgs.14430 ◽

2016 ◽

Vol 64 (10) ◽

pp. e67-e71 ◽

Cited By ~ 3

Author(s):

Sarah L. Gold ◽

Kristen Gilmore Powell ◽

Michael H. Eversman ◽

N. Andrew Peterson ◽

Suzanne Borys ◽

...

Keyword(s):

Older Adults ◽

New Jersey ◽

High Risk ◽

Prescription Drugs ◽

Prescription Opioids

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Interfering Medications in Older Adults on Thyroid Hormone Replacement: Who Is at Risk?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1694 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A831-A831

Author(s):

Rachel Beeson ◽

Antoinette B Coe ◽

David Reyes-Gastelum ◽

Megan R Haymart ◽

Maria Papaleontiou

Keyword(s):

Older Adults ◽

Thyroid Hormone ◽

Thyroid Function ◽

Hormone Replacement ◽

Patient Characteristics ◽

Population Based ◽

Thyroid Function Tests ◽

Thyroid Hormone Replacement ◽

Function Tests ◽

Concurrent Use

Abstract Background: Thyroid hormone prescriptions have steadily increased in the past few years with levothyroxine being one of the most frequently prescribed medications in the United States. Population-based studies have shown that older age is a significant predictor for thyroid hormone initiation, with use continuing long-term. Thyroid hormone management in older adults is complicated by the presence of comorbidities and polypharmacy, particularly due to medications that can interfere with thyroid function tests. However, the prevalence of concurrent use of thyroid hormone and interfering medications in older adults and patient characteristics associated with this practice remain unknown. Methods: We conducted a population-based, retrospective cohort study of 538,137 thyroid hormone users aged ≥65 years from the Corporate Data Warehouse of the Veterans Health Administration (2004-2017). First, we described the prevalence of concurrent use of thyroid hormone and medications that commonly interfere with thyroid function tests (i.e., prednisone, prednisolone, carbamazepine, phenytoin, phenobarbital, amiodarone, lithium, interferon-alpha, tamoxifen). Then, we performed a multivariable logistic regression analysis to determine patient characteristics associated with concurrent use of thyroid hormone and at least one interfering medication during the study period. Covariates included in the model were patient age, sex, race, ethnicity and number of comorbidities. Results: Overall, 170,261 (31.6%) of patients were on at least one interfering medication while on thyroid hormone during the study period (median follow up 56 months). Non-white race [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.15-1.21], compared to white race), Hispanic ethnicity (OR 1.11, 95% CI 1.08-1.14, compared to non-Hispanic), female sex (OR 1.12, 95% CI 1.08-1.15, compared to male sex), and presence of comorbidities (e.g. Charlson-Deyo Comorbidity Score ≥2, OR 2.47, 95% CI 2.43-2.52, compared to zero) were more likely to be associated with concurrent use of thyroid hormone and interfering medications. Older age (e.g., ≥85 years, OR 0.47, 95% CI 0.46 - 0.48, compared to age 65-74 years) was less likely to be associated with concurrent use of thyroid hormone and interfering medications. Conclusions: Almost one-third of older adults on thyroid hormone were taking medications that have been known to interfere with thyroid function tests. Our study highlights the complexity of managing thyroid hormone replacement in older patients, many of whom are at risk for adverse effects in the context of polypharmacy and comorbidities.

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Prevalence of drug–herb and drug–supplement interactions in older adults: a cross-sectional survey

British Journal of General Practice ◽

10.3399/bjgp18x699101 ◽

2018 ◽

Vol 68 (675) ◽

pp. e711-e717 ◽

Cited By ~ 14

Author(s):

Taofikat B Agbabiaka ◽

Neil H Spencer ◽

Sabina Khanom ◽

Claire Goodman

Keyword(s):

Older Adults ◽

Drug Interactions ◽

Dietary Supplements ◽

Prescription Drugs ◽

Community Dwelling ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Evening Primrose ◽

Supplement Use ◽

Concurrent Use

BackgroundPolypharmacy is common among older adults, with increasing numbers also using prescription drugs with herbal medicinal products (HMPs) and dietary supplements. There is no reliable evidence from the UK on concurrent use of HMPs and dietary supplements with prescription drugs in older adults.AimTo establish prevalence of concurrent prescription drugs, HMPs, and dietary supplements among UK community-dwelling older adults and identify potential interactions.Design and settingCross-sectional survey of older adults registered at two general practices in South East England.MethodA questionnaire asking about prescription medications, HMPs, and sociodemographic information was posted to 400 older adults aged ≥65 years, identified as taking ≥1 prescription drug.ResultsIn total 155 questionnaires were returned (response rate = 38.8%) and the prevalence of concurrent HMPs and dietary supplements with prescriptions was 33.6%. Females were more likely than males to be concurrent users (43.4% versus 22.5%; P = 0.009). The number of HMPs and dietary supplements ranged from 1 to 8, (mean = 3, median = 1; standard deviation = 1.65). The majority of concurrent users (78.0%) used dietary supplements with prescription drugs. The most commonly used dietary supplements were cod liver oil, glucosamine, multivitamins, and vitamin D. Others (20.0%) used only HMPs with prescription drugs. Common HMPs were evening primrose oil, valerian, and Nytol Herbal® (a combination of hops, gentian, and passion flower). Sixteen participants (32.6%) were at risk of potential adverse drug interactions.ConclusionGPs should routinely ask questions regarding herbal and supplement use, to identify and manage older adults at potential risk of adverse drug interactions.

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Psychoactive Substance Use Among Middle-Aged and Older Adults With Visual Impairment

Innovation in Aging ◽

10.1093/geroni/igab046.3518 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 987-988

Author(s):

Francisco Lopez ◽

Jason Leddy ◽

Benjamin Han ◽

Joseph Palamar

Keyword(s):

Older Adults ◽

Substance Use ◽

Visual Impairment ◽

Nicotine Dependence ◽

Vision Loss ◽

Prescription Opioids ◽

Psychoactive Substance ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Psychoactive Substance Use

Abstract Older adults with visual impairment may be at risk for developing substance use disorder (SUD) as psychoactive substance use is often used to cope with the stressors of vision loss. This study estimates the national prevalence and risk of psychoactive substance use among older adults with visual impairment. We analyzed data of respondents age ≥50 from the 2015-2019 National Survey on Drug Use and Health, an annual cross-sectional survey of a nationally representative sample of non-institutionalized individuals in the U.S. (N=43,886). We estimated and compared prevalence of past-year use of cannabis, cocaine, misuse of prescription opioids, sedatives, stimulants/tranquilizers, alcohol use disorder (AUD), any SUD, and nicotine dependence between adults with visual impairment to those without. Comparisons were conducted using chi-square and we used multivariable generalized linear models using Poisson and log link to estimate adjusted prevalence ratios (aPRs) for adults with visual impairment relative to those without, controlling for demographics and diagnosis of ≥2 chronic diseases. An estimated 6.1% experienced visual impairment. Those with visual impairment had higher prevalence of AUD, nicotine dependence, misuse of prescription opioids, tranquilizers, and stimulants, and SUDs. In adjusted analyses, vision-impaired adults had higher risk of AUD (aPR=1.71, 95% CI: 1.40-2.09), nicotine dependence (aPR =1.53, 95% CI:1.35-1.73), opioid misuse (aPR =1.54, 95% CI:1.26-1.90), and SUD (aPR=1.67, 95% CI:1.40-2.01). Psychoactive substance use adds unique health risks for older adults with vision loss, who may suffer significant psychological stress and loss of independence. Screening for substance use among all older adults with visual impairment should be considered.

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