Trends in short-term, long-term, and high-risk opioid use among older cancer patients.

Abstract

187 Background: While opioids represent a cornerstone of cancer pain management, the timing and patterns of persistent and high-risk opioid use in the context of the ongoing opioid epidemic are not well studied. This study sought to explore longitudinal trends in short-term, long-term, and high-risk opioid use among older cancer patients. Methods: Within a cohort of 84,994 Medicare beneficiaries ≥ 65 years old diagnosed with cancer between 2007 and 2013, we determined the likelihood of being prescribed an opioid after cancer diagnosis (0-6 months, 6-12 months, and 1-2 years post-diagnosis) and of receiving a daily morphine equivalent dose (MED) ≥ 200 mg, a dose associated with higher opioid-related mortality. Multivariable logistic regression models were used to identify patient and cancer risk factors associated with outcomes. Results: The rates of opioid prescription at 0 to 6 months, 6 to 12 months, and 1 to 2 years after diagnosis were 60.7%, 32.7%, and 38.2% respectively. Among patients who were prescribed an opioid, 4.0% received a MED ≥ 200 mg within 2 years of diagnosis. The likelihood of opioid prescription 0 to 6 months after diagnosis increased over the study period (OR = 1.05 per year, CI = 1.04 to 1.06), while the likelihood of opioid prescription 6 to 12 months (OR = 0.98 per year, CI = 0.97 to 0.99) and 1 to 2 years (OR = 0.98 per year, CI = 0.97 to 0.99) after diagnosis decreased over the study period. The probability of receiving a MED ≥ 200 mg decreased over the study period (OR = 0.98 per year, CI = 0.96 to 0.99). On multivariable analysis, Black (OR = 1.14, CI = 1.06 to 1.23) and American Indian/Native Alaskan (OR = 1.46, CI = 1.06 to 2.02) patients were more likely to receive opioids 1 to 2 years after diagnosis. Patients living in areas with higher rates of poverty (OR = 1.40, CI = 1.32 to 1.48) were also more likely to receive an opioid 1 to 2 years after diagnosis. Black (OR = 1.72, CI = 1.59 to 1.86), Asian (OR = 1.46, CI = 1.19 to 1.80), and Hispanic (OR = 1.36, CI = 1.23 to 1.51) patients were more likely to receive a MED ≥ 200 mg. Conclusions: While the rate of short-term opioid use is rising, rates of persistent and high-risk opioid use are declining among cancer patients. This may reflect growing awareness of the dangers of opioid misuse among clinicians treating patients with cancer. Nevertheless, racial and socioeconomic disparities in patterns of opioid use are persistent in the cancer population.