scholarly journals Opioid use in Older Orthopedic Rehabilitation Inpatients: A Retrospective Study

2021 ◽  
Author(s):  
Aaron Jason Bilek ◽  
Stephanie Cullen ◽  
Carolyn Michelle Tan ◽  
Qixuan Li ◽  
Ella Huszti ◽  
...  
Keyword(s):  
Older Adults ◽  
Adult Population ◽  
Oral Morphine ◽  
Inpatient Rehabilitation ◽  
Medication Administration ◽  
Opioid Use ◽  
Opioid Dose ◽  
Orthopedic Rehabilitation ◽  
Orthopedic Patients ◽  
Opioid Users

Abstract Background: While there is much evidence about pain management for orthopedic patients in the immediate perioperative setting, little is known about how opioids are used during inpatient rehabilitation in the days and weeks that follow, particularly in older adults. A safe upper limit of 50 oral morphine equivalents (OME) is frequently cited in guidelines. This study’s objective is to characterize the use of opioids in an older adult population undergoing orthopedic rehabilitation. Methods: This is a retrospective observational study of adults aged ≥50 years old admitted for orthopedic rehabilitation between November 2019 and June 2021 at an academic rehabilitation hospital in Toronto, Canada. Acute care admissions preceding rehabilitation were for either a surgical or non-surgical orthopedic indication. Participants were divided into opioid-naïve individuals who received opioids, opioid-naïve individuals who did not receive opioids, and pre-existing chronic users of opioids. Demographic, clinical, and medication administration data were collected through the electronic health record and manual chart review. Average daily opioid dose for the first seven days of each stay was characterized using OME. Linear regression was used to assess for variables independently associated with opioid dose. Results: A total of 643 patients undergoing orthopedic rehabilitation were included: 125 (19.4%) involved chronic opioid users, 416 (64.7%) were opioid-naïve patients who received opioids, and 102 (15.9%) were opioid-naïve patients who did not receive opioids, with median age respectively of 72, 79, and 83. Median daily OME over the first week for chronic users was 30.3 and for opioid-naïve users was 6.9. Opioid dose was significantly positively associated with reported pain as defined by day 3 pain score and knee replacement; it was inversely associated with admission for a non-surgical indication and age. Conclusions: Opioids are frequently but heterogeneously used in older adults undergoing orthopedic rehabilitation. Median OME use in this cohort of older adults was substantially lower than the 50 OME threshold suggested in guidelines. Dedicated guidance for opioid use is warranted for this unique patient population.

scholarly journals Identifying Predictive Characteristics of Opioid Medication Use among a Nationally Representative Sample of United States Older Adults with Pain and Comorbid Hypertension or Hypercholesterolemia

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 341
Author(s):  
David R. Axon ◽  
Shannon Vaffis ◽  
Srujitha Marupuru
Keyword(s):  
United States ◽  
Older Adults ◽  
Representative Sample ◽  
Chronic Conditions ◽  
Functional Limitation ◽  
The United States ◽  
Medical Expenditure ◽  
Opioid Use ◽  
Nationally Representative ◽  
Opioid Users

The prevalence of older adults with pain and comorbid cardiovascular conditions is increasing in the United States (U.S.). This retrospective, cross-sectional database study used 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models to identify predictive characteristics of opioid use among a nationally representative sample of older U.S. adults (aged ≥50 years) with pain in the past four weeks and comorbid hypertension (pain–hypertension group) or hypercholesterolemia (pain–hypercholesterolemia group). The pain–hypertension group included 2733 subjects (n = 803 opioid users) and the pain–hypercholesterolemia group included 2796 subjects (n = 795 opioid users). In both groups, predictors of opioid use included: White race versus others, Hispanic versus non-Hispanic ethnicity, 1 versus ≥5 chronic conditions, little/moderate versus quite a bit/extreme pain, good versus fair/poor perceived mental health, functional limitation versus no functional limitation, smoker versus non-smoker, and Northeast versus West census region. In addition, Midwest versus West census region was a predictor in the pain–hypertension group, and 4 versus ≥5 chronic conditions was a predictor in the pain–hypercholesterolemia group. In conclusion, several characteristics of older U.S. adults with pain and comorbid hypertension or hypercholesterolemia were predictive of opioid use. These characteristics could be addressed to optimize individuals’ pain management and help address the opioid overdose epidemic.

scholarly journals Canadian Guidelines on Opioid Use Disorder Among Older Adults

2020 ◽  
Vol 23 (1) ◽  
pp. 123-134
Author(s):  
Launette M. Rieb ◽  
Zainab Samaan ◽  
Andrea D. Furlan ◽  
Kiran Rabheru ◽  
Sid Feldman ◽  
...  
Keyword(s):  
Older Adults ◽  
English Language ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Assessment And Treatment ◽  
Noncancer Pain ◽  
Health Canada

BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.

Pre-operative opioid use in gynecologic oncology: a common comorbidity relevant to the peri-operative period

2019 ◽  
Vol 29 (9) ◽  
pp. 1411-1416
Author(s):  
Megan Elizabeth Ross ◽  
Lindsay J Wheeler ◽  
Dina M Flink ◽  
Carolyn Lefkowits
Keyword(s):  
Length Of Stay ◽  
Gynecologic Oncology ◽  
Oral Morphine ◽  
Opioid Use ◽  
Oncology Patients ◽  
Opioid Prescription ◽  
Operative Outcomes ◽  
Operative Planning ◽  
Opioid Users ◽  
The Relationship

ObjectivesPre-operative opioid use is common and should be considered a comorbidity among surgical candidates. Our objective was to describe the rate of pre-operative opioid use and patterns of post-operative outpatient opioid prescribing in a cohort of gynecologic oncology patients.MethodsA retrospective cohort study was conducted with 448 gynecologic oncology surgical patients undergoing surgery for a suspected or known cancer diagnosis from January 2016 to December 2016. Pre-operative opioid users (n=97) were identified. Patient and surgical characteristics were abstracted, as was post-operative opioid prescription (type of opioid, oral morphine equivalents amount) and length of stay. For pre-operative opioid users, the type of opioid prescribed post-operatively was compared with the type of pre-operative opioid. Pre-operative opioid users were compared with non-users, stratified by surgery type. Descriptive statistics were analyzed using χ2 statistic, and medians were compared using a Mann-Whitney U statistic.ResultsPre-operative opioid prescriptions were noted in 21% of patients, and 24% of these had two or more opioid prescriptions before surgery. The majority of pre-operative opioid users (51%) were maintained on the same agent post-operatively at the time of discharge, but 36% were switched to a different opioid and 7% were prescribed an additional opioid. Overall and in laparotomies, pre-operative opioid users received higher volume post-operative prescriptions than non-users. There was no difference in post-operative prescription volume for minimally invasive surgeries or in length of stay between pre-operative users and non-users.ConclusionsPre-operative opioid use is common in gynecologic oncology patients and should be considered during pre-operative planning. Pre-operative opioid use was associated with a higher volume and wider range of post-operative prescription. Over 40% of opioid users were discharged with either an additional opioid or a new opioid, highlighting a potential missed opportunity to optimize opioid safety. Further research is needed to characterize the relationship between pre-operative opioid use and peri-operative outcomes and to develop strategies to manage pain effectively in this population without compromising opioid safety.

scholarly journals Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data

Pain Medicine ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 521-531 ◽  
Author(s):  
Meridith Blevins Peratikos ◽  
Hannah L Weeks ◽  
Andrew J B Pisansky ◽  
R Jason Yong ◽  
Elizabeth Ann Stringer
Keyword(s):  
Length Of Stay ◽  
Claims Data ◽  
The United States ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Administrative Claims ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Dose ◽  
Opioid Users

Abstract Objective Between 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes. Design Retrospective study of administrative medical and pharmaceutical claims data. Subjects Adults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014–2015. Methods A patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1–30 and 31–90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities, and utilization. Results Among 34,792 patients (38% hip, 58% knee, 4% shoulder), 6,043 (17.4%) were preoperative opioid users with a median morphine equivalent daily dose of 32 mg. Preoperative opioid users had increased length of stay (IRR = 1.03, 95% CI = 1.02 to 1.05), nonhome discharge (OR = 1.10, 95% CI = 1.00 to 1.21), and 30-day unplanned readmission (OR = 1.43, 95% CI = 1.17 to 1.74); experienced 35% higher surgical site infection (HR = 1.35, 95% CI = 1.14 to 1.59) and 44% higher surgical revision (HR = 1.44, 95% CI = 1.21 to 1.71); had a median $1,084 (95% CI = $833 to $1334) increase in medical spend during the 365 days after discharge; and had a 64% lower rate of opioid cessation (HR = 0.34, 95% CI = 0.33 to 0.35) compared with patients not filling two or more prescriptions across periods. Conclusions Preoperative opioid users had longer length of stay, increased revision rates, higher spend, and persistent opioid use, which worsened with dose. Adverse outcomes after elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.

Changes in opioid prescribing behaviour in Denmark, Sweden and Norway - 2006-2014

2016 ◽  
Vol 12 (1) ◽  
pp. 121-121
Author(s):  
L. Jarlbaek ◽  
P. Joergensen
Keyword(s):  
Oral Morphine ◽  
Opioid Use ◽  
The Public ◽  
Opioid Prescribing ◽  
Defined Daily Doses ◽  
Consumption Data ◽  
Prescribing Behaviour ◽  
Strong Opioids ◽  
Opioid Users ◽  
Prescription Databases

Abstract Aims A country’s use of opioids is frequently debated in the public, usually based on rough figures from prescription databases made for consumption registration purposes. However, these databases hold much more detailed information that can be processed to increase knowledge and insight into nationally opioid prescribing-behaviour. This study aims to provide a more detailed picture of opioid prescribing and its changes in Denmark, Sweden and Norway during 2006-2014. Methods Data on opioid-use (ATC; N02A) were downloaded from each country’s publically assessable prescription-databases. Consumption-data were converted from defined daily doses (DDDs) to mg oral morphine equivalents (omeqs). Changes in choice of opioid-types, use and number of users were presented using descriptive statistics and compared. Results Opioid users: During the whole period, Norway had the highest, and Denmark the lowest, number of opioid users/1000 inhabitants. In 2006, Norway, Sweden and Denmark had 98, 79, 66 users/1000 inhabitants. In 2014 the numbers were 105, 78, 75 users/1000 inhabitants, respectively. Opioid use/user: During the whole period, Norway had the lowest, and Denmark the highest use/user. In 2006, the mean use/user was 1979, 3615, 6025 mg omeq/user in Norway, Sweden and Denmark respectively. In 2014 the corresponding use was 2426,3473,6361 mg omeq/user. The preferred choices of opioid-types changed during the period for all three countries. The balance between use of weak or strong opioids showed more prominent changes for Norway and Sweden compared to Denmark. Conclusions Three nations, closely related in culture and geo graphically, showed significant differences and changes in opioid prescribing behaviour. This knowledge can easily be overlooked using the traditional way of presenting opioid consumption statistics. More detailed and clinically relevant presentation can increase the knowledge of doctors’ opioid prescribing behaviour, that can be related to changes in the society or health care system, like demography, legislation and guidelines from authorities.

Risk of chronic opioid use after simultaneous versus staged bilateral knee arthroplasty

2020 ◽  
pp. rapm-2020-102060
Author(s):  
Lauren Wilson ◽  
Megan Fiasconaro ◽  
Jiabin Liu ◽  
Jashvant Poeran ◽  
Lazaros Poultsides ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Oral Morphine ◽  
Opioid Use ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Chronic Opioid Use ◽  
Opioid Users ◽  
Multivariable Regression Models ◽  
Adjusted Model ◽  
Timing Strategies

BackgroundSeveral studies have identified excess risk associated with undergoing simultaneous (compared with unilateral or staged) bilateral total knee arthroplasty (BTKA). However, few have addressed subsequent chronic opioid use. Given the substantial morbidity and mortality associated with prolonged opioid use, we evaluated the incidence of postoperative chronic opioid use following simultaneous versus staged BTKA, based on the different timing strategies of staged procedures.MethodsIn this retrospective cohort study, patients who underwent BTKA procedures (2012–2016; Truven Health MarketScan; n=14 407) were classified as having undergone simultaneous or staged BTKA (<3 months, 3–6 months or 6–12 months apart). Outcomes were postoperative chronic opioid use and oral morphine equivalents prescribed on discharge. Multivariable regression models measured associations between type/timing of BTKA and outcomes. ORs and 95% CIs were reported.ResultsUnadjusted frequency of chronic opioid use did not differ between groups, (Simultaneous: 11.3%, staged <3 months: 10.7%, staged 3–6 months: 11.7%, staged >6 months: 10.2%; p=0.247). In an adjusted model, there was no significant difference in the odds of becoming chronic opioid users between staged and simultaneous BTKA (staged <3 months OR 1.03, 95% CI 0.88 to 1.21/staged 3–6 months OR 0.94, 95% CI 0.79 to 1.12/staged >6 months OR 0.96, 95% CI 0.82 to 1.13; p=0.755). Patients undergoing staged BTKAs <6 months apart (compared with simultaneous) were prescribed slightly greater oral morphine equivalents on hospital discharge (staged <3 months 6% increase, 95% CI 3% to 10%; staged 3–6 months 4%, 95% CI 1% to 8%; p=0.002).ConclusionAlthough patients undergoing staged BTKA <6 months apart were prescribed greater quantities of opioids on discharge, there was no significant difference in the odds of postoperative chronic opioid use compared with simultaneous BTKA. The timing of BTKA procedures does not appear to influence the likelihood of postoperative chronic opioid dependence.

scholarly journals Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients

2018 ◽  
Vol 13 (5) ◽  
pp. 746-753 ◽  
Author(s):  
Julie H. Ishida ◽  
Charles E. McCulloch ◽  
Michael A. Steinman ◽  
Barbara A. Grimes ◽  
Kirsten L. Johansen
Keyword(s):  
Confidence Interval ◽  
Mental Status ◽  
Oral Morphine ◽  
Altered Mental Status ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Dependent Manner ◽  
Opioid Use ◽  
Opioid Dose ◽  
Dose Increment

Background and objectivesPatients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited.Design, setting, participants, & measurementsUsing the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. We evaluated risk according to average daily total opioid dose (>60 mg, ≤60 mg, and per 60-mg dose increment) and specific agents (per 60-mg dose increment).ResultsThe median age was 61 years old, 52% were men, and 50% were white. Sixty-four percent received opioids, and 17% had an episode of altered mental status (15,658 events), fall (7646 events), or fracture (4151 events) in 2011. Opioid use was associated with risk for all outcomes in a dose-dependent manner: altered mental status (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.23 to 1.34; higher dose: hazard ratio, 1.67; 95% confidence interval, 1.56 to 1.78; hazard ratio, 1.29 per 60 mg; 95% confidence interval, 1.26 to 1.33), fall (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.21 to 1.36; higher dose: hazard ratio, 1.45; 95% confidence interval, 1.31 to 1.61; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.03 to 1.05), and fracture (lower dose: hazard ratio, 1.44; 95% confidence interval, 1.33 to 1.56; higher dose: hazard ratio, 1.65; 95% confidence interval, 1.44 to 1.89; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.04 to 1.05). All agents were associated with a significantly higher hazard of altered mental status, and several agents were associated with a significantly higher hazard of fall and fracture.ConclusionsOpioids were associated with adverse outcomes in patients on hemodialysis, and this risk was present even at lower dosing and for agents that guidelines have recommended for use.

scholarly journals Opioid use in medical cannabis authorization adult patients from 2013 to 2018: Alberta, Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cerina Lee ◽  
Mu Lin ◽  
Karen J. B. Martins ◽  
Jason R. B. Dyck ◽  
Scott Klarenbach ◽  
...  
Keyword(s):  
Oral Morphine ◽  
Interrupted Time Series ◽  
The United States ◽  
Adult Patients ◽  
Opioid Overdose ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Absolute Increase ◽  
Health Crisis ◽  
Opioid Users

Abstract Background The opioid overdose epidemic in Canada and the United States has become a public health crisis - with exponential increases in opioid-related morbidity and mortality. Recently, there has been an increasing body of evidence focusing on the opioid-sparing effects of medical cannabis use (reduction of opioid use and reliance), and medical cannabis as a potential alternative treatment for chronic pain. The objective of this study is to assess the effect of medical cannabis authorization on opioid use (oral morphine equivalent; OME) between 2013 and 2018 in Alberta, Canada. Methods All adult patients defined as chronic opioid users who were authorized medical cannabis by their health care provider in Alberta, Canada from 2013 to 2018 were propensity score matched to non-authorized chronic opioid using controls. A total of 5373 medical cannabis patients were matched to controls, who were all chronic opioid users. The change in the weekly average OME of opioid drugs for medical cannabis patients relative to controls was measured. Interrupted time series (ITS) analyses was used to assess the trend change in OME during the 26 weeks (6 months) before and 52 weeks (1 year) after the authorization of medical cannabis among adult chronic opioid users. Results Average age was 52 years and 54% were female. Patients on low dose opioids (< 50 OME) had an increase in their weekly OME per week (absolute increase of 112.1 OME, 95% CI: 104.1 to 120.3); whereas higher dose users (OME > 100), showed a significant decrease over 6 months (− 435.5, 95% CI: − 596.8 to − 274.2) compared to controls. Conclusions This short-term study found that medical cannabis authorization showed intermediate effects on opioid use, which was dependent on initial opioid use. Greater observations of changes in OME appear to be in those patients who were on a high dosage of opioids (OME > 100); however, continued surveillance of patients utilizing both opioids and medical cannabis is warranted by clinicians to understand the long-term potential benefits and any harms of ongoing use.

scholarly journals RURALITY, ALCOHOL, AND OPIOID USE AS PRECURSOR TO ELDER ABUSE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S762-S763
Author(s):  
Faika Zanjani
Keyword(s):  
Older Adults ◽  
Risk Management ◽  
Substance Use ◽  
Health Professionals ◽  
Rural Areas ◽  
Community Education ◽  
Elder Abuse ◽  
Adult Population ◽  
Dissemination And Implementation ◽  
Opioid Use

Abstract Pain, alcohol, and opioid risk management is an increasingly important issue in the care of the older adult population. Older adults are at higher risk for pain and the negative outcomes associated with opioid and alcohol use due to higher prevalence of multimorbidity, polypharmacy, and the age-associated changes in metabolism and elimination. Evidence-based approaches for pain and substance use management exist and are effective for older adults, but underutilized and have limited availability in rural areas. Therein, undermanagement of pain and substance use becomes a risk factor for elder abuse. Improved dissemination and implementation in practice, as well as training for health professionals and the community is needed to better realize and prevent negative health outcomes from pain, alcohol, and opioid use. Community education and training tools for health professionals will be discussed, with suggestions for community initiatives to address pain, alcohol, and opioid risk management to prevent elder abuse.

scholarly journals Concurrent use of opioids and benzodiazepines/Z-drugs in Alberta, Canada and the risk of hospitalisation and death: a case cross-over study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038692
Author(s):  
Vishal Sharma ◽  
Scot H Simpson ◽  
Salim Samanani ◽  
Ed Jess ◽  
Dean T Eurich
Keyword(s):  
Drug Use ◽  
Population Based ◽  
Matched Pair ◽  
Health Providers ◽  
Opioid Use ◽  
Opioid Dose ◽  
Concurrent Use ◽  
Estimated Risk ◽  
Ed Visits ◽  
Opioid Users

ObjectivesCoprescribing of benzodiazepines/Z-drugs (BZDs) and opioids is a drug-use pattern of considerable concern due to risk of adverse events. The objective of this study is to estimate the effect of concurrent use of BZDs on the risk of hospitalisations/emergency department (ED) visits and deaths among opioid users.Design, setting and participantsWe conducted a population-based case cross-over study during 2016–2018 involving Albertans 18 years of age and over who received opioids. From this group, we identified 1 056 773 people who were hospitalised or visited the ED, and 31 998 who died.InterventionConcurrent use of opioids and BZDs.OutcomesWe estimated the risk of incident all-cause hospitalisation/ED visits and all-cause mortality associated with concurrent BZD use by applying a matched-pair analyses comparing concurrent use to opioid only use.ResultsConcurrent BZD use occurred in 17% of opioid users (179 805/1 056 773). Overall, concurrent use was associated with higher risk of hospitalisation/ED visit (OR 1.13, p<0.001) and all cause death (OR 1.90; p<0.001). The estimated risk of hospitalisation/ED visit was highest in those >65 (OR 1.5; p<0.001), using multiple health providers (OR 1.67; p<0.001) and >365 days of opioid use (OR 1.76; p<0.001). Events due to opioid toxicity were also associated with concurrent use (OR 1.8; p<0.001). Opioid dose-response effects among concurrent patients who died were also noted (OR 3.13; p<0.001).InterpretationConcurrent use of opioids and BZDs further contributes to the risk of hospitalisation/ED visits and mortality in Alberta, Canada over opioid use alone, with higher opioid doses, older age and increased number of unique health providers carrying higher risks. Regulatory bodies and health providers should reinforce safe drug-use practices and be vigilant about coprescribing.

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