Use of Opioids Increases With Age in Older Adults: An Observational Study (2005-2017).

Yvette M Weesie,Tjard R J Schermer,Tjard R J Schermer,Tjard R J Schermer,Elisabeth J Rook,Hubertus G M Leufkens,Karin Hek,Francois G Schellevis,Liset Van Dijk,Liset Van Dijk

doi:10.3389/fphar.2020.00648

Abstract

AimPain is increasingly treated with opioids. Potential harms of opioid therapy disproportionally affect older patients. This study aims to provide information on trends, nature and duration of opioid prescribing to older adults, in primary care and to explore differences between older patients from different ages.MethodsPrimary care data (2005–2017) were derived from routine electronic medical records of patients in Nivel Primary Care Database. All opioid prescriptions with Anatomical Therapeutic Chemical Classification (ATC) code N02A were selected (except for codeine). Diagnoses were recorded using the International Classification of Primary Care (ICPC). Patients were categorized in three age groups (65–74, 75–84, and ≥85 years). Descriptive analyses were used to describe the trend of opioid prescriptions for specific opioids, the duration of use and underlying diagnoses.Results283,600 patients were included of which 32,287 had at least one opioid prescription in 2017. An increase in the number of older adults who received at least one opioid was seen between 2005 and 2017. The oldest patients were more likely to be prescribed an opioid, especially when it comes to strong opioids, the increase in the volume of prescribing was highest in this group. Moreover, over 40% of the oldest patients used strong opioids chronically. Strong opioids were mostly prescribed for musculoskeletal diagnoses. Cancer was the second most common diagnosis for strong opioids in the younger subgroups, whereas less specified diagnoses were as second in the oldest subgroup.ConclusionOpioid prescription changes with increasing age in frequency, nature, and duration, despite higher harm risks among older patients. Because of the high prevalence of chronic use, it is important to monitor the patient throughout the treatment and to critically evaluate the initiation and continuation of opioid prescriptions.

Highlights

One out of five adults in Europe experience moderate to severe pain which seriously affects their daily life (Breivik et al, 2006)
There was an increase over the years in the number of patients who received at least one opioid prescription and of patients with at least one prescription of a strong opioid see Table A1 in the Appendix
The increase in prescriptions of strong opioids was larger in patients aged 85 years or older compared to the two younger age groups

Summary

Introduction

One out of five adults in Europe experience moderate to severe pain which seriously affects their daily life (Breivik et al, 2006). While strong opioids are very effective painrelieving medicines, the evidence for their benefits in long term use is limited (Kissin, 2013; Sites et al, 2014; Chou et al, 2015), and several risks have been reported. These include increased risk for side effects (such as constipation, nausea, and sedation), addiction, hospitalization, and even mortality (Calcaterra et al, 2013; Franklin, 2014; Currow et al, 2016). The sharpest increase is seen for strong opioids (Zin et al, 2014; van Amsterdam and van den Brink, 2015) which are often used longterm (Olsen et al, 2006; Foy et al, 2016)

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