Objectives: To examine the effect of age on the likelihood of PIP of opioids and the effect of PIP on adverse outcomes. Design: Retrospective cohort study. Setting: Data from multiple state agencies in Massachusetts from 2011 to 2015. Participants: Adult Massachusetts residents (N=3,078,163) who received at least one prescription opioid during the study period; approximately half (1,589,365) aged 50 and older. Measurements: We measured exposure to 5 types of PIP: high-dose opioids, coprescription with benzodiazepines, multiple opioid prescribers, multiple opioid pharmacies, and continuous opioid therapy without a pain diagnosis. We examined 3 adverse outcomes: nonfatal opioid overdose, fatal opioid overdose, and all-cause mortality. Results: The rate of any PIP increased with age, from 2% of individuals age 18 to 29 to 14% of those aged 50 and older. Older adults also had higher rates of exposure to 2 or more different types of PIP (40–49, 2.5%; 50–69, 5%; ≥70, 4%). Of covariates assessed, older age was the greatest predictor of PIP. In analyses stratified according to age, any PIP and specific types of PIP were associated with nonfatal overdose, fatal overdose, and all-cause mortality in younger and older adults. Conclusion: Older adults are more likely to be exposed to PIP, which increases their risk of adverse events. Strategies to reduce exposure to PIP and to improve outcomes in those already exposed will be instrumental to addressing the opioid crisis in older adults. J Am Geriatr Soc 67:128–132, 2019.
Bibliographical noteFunding Information:
Financial Disclosure: This research was funded by the GE Foundation (PI: Stopka). Dr. Stein was supported in part by P50DA046351-01. Dr. Larochelle was supported by National Institute on Drug Abuse Grant K23 DA042168, National Center for Advancing Translational Sciences, National Institutes of Health, through Boston University Clinical and Translational Science Institute Grant 1UL1TR001430, and a Boston University School of Medicine Department of Medicine Career Investment Award. The funders had no role in the study design, methods, collection of data, analysis, manuscript writing, or decision to submit the manuscript for publication.
© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society
- opioid overdose
- potentially inappropriate prescribing