Non-opioid Users Research Articles

Risk of prolonged postoperative opioid use after elective shoulder replacement: a nationwide cohort study of 5,660 patients from the Danish Shoulder Arthroplasty Registry.

Several studies from the United States report an increased risk of prolonged opioid use after shoulder replacement. We aimed to determine the incidence and risk factors of prolonged opioid use after elective shoulder replacement in a nationwide Danish population. All primary elective shoulder arthroplasties reported to the Danish Shoulder Arthroplasty Registry (DSR) from 2004 to 2020 were screened for eligibility. Data on potential risk factors was retrieved from the DSR and the National Danish Patient Registry while data on medication was retrieved from the Danish National Health Service Prescription Database. Prolonged opioid use was defined as 1 or more dispensed prescriptions on and 90 days after date of surgery (Q1) and subsequently 1 or more dispensed prescriptions 91-180 days after surgery (Q2). Preoperative opioid use was defined as 1 or more dispensed prescriptions 90 days before surgery. Logistic regression models were used to estimate risk factors for prolonged opioid use. We included 5,660 patients. Postoperatively 1,584 (28%) patients were dispensed 1 or more prescriptions in Q1 and Q2 and were classified as prolonged opioid users. Among the 2,037 preoperative opioid users and the 3,623 non-opioid users, 1,201 (59%) and 383 (11%) respectively were classified as prolonged users. Preoperative opioid use, female sex, alcohol abuse, previous surgery, high Charlson Comorbidity index, and preoperative use of either antidepressants, antipsychotics, or benzodiazepines were associated with increased risk of prolonged opioid use. The incidence of prolonged opioid use was 28%. Preoperative use of opioids was the strongest risk factor for prolonged opioid use, but several other risk factors were identified for prolonged opioid use.

Preoperative Opioid Use Increases Postoperative Opioid Demand, but Not Length of Stay After Spine Trauma Surgery

BackgroundPreoperative opioid use has been well-studied in elective spinal surgery and correlated with numerous postoperative complications including increases in immediate postoperative opioid demand (POD), continued opioid use postoperatively, prolonged length of stay (LOS), readmissions, and disability. There is a paucity of data available on the use of preoperative opioids in surgery for spine trauma, possibly because there are minimal options for opioid reduction prior to emergent spinal surgery. Nevertheless, patients with traumatic spinal injuries are at a high risk for adverse postoperative outcomes. This study investigated the effects of preoperative opioid use on POD and LOS in spine trauma patients. Methods130 patients were grouped into two groups for primary comparison: Group 1 (Preoperative Opioid Use, N=16) and Group 2 (No Opioid Use, N=114). Two subgroups of Group 2 were used for secondary analysis against Group 1: Group 3 (No Substance Abuse, N=95) and Group 4 (Other Substance Abuse, N=19). Multivariable analysis was used to determine if there were significant differences in POD and LOS. ResultsPrimary analysis demonstrated that preoperative opioid users required an estimated 97.5 mg/day more opioid medications compared to non-opioid users (p<0.001). Neither primary nor secondary analysis showed a difference in LOS in any of the comparisons. ConclusionsPreoperative opioid users had increased POD compared to non-opioid users and patients abusing other substances, but there was no difference in LOS. We theorize the lack of difference in LOS may be due to the enhanced perioperative recovery protocol used, which has been demonstrated to reduce LOS.

An Overview of Opioid Prescription Patterns among Non-Opioid Users Following Emergency Department Admission.

The evolving landscape of opioid prescription practices necessitates a comprehensive understanding of emerging patterns, particularly among new opioid users discharged from emergency departments. This study delves into the intricate realm of opioid utilization by elucidating the prevalence of their prescriptions. A retrospective analysis of electronic health records was conducted, including a cohort of 71 patients who received opioid prescriptions upon discharge from emergency departments from 1 January 2022 to 30 June 2022. Demographic characteristics and prescription details were systematically examined. This study illuminates tramadol's prominence, with 84% of prescriptions and a Defined Daily Dose (DDD) morphine equivalent of 60 mg, as the primary choice as a new opioid, a finding that draws attention due to the closely aligned dosages with morphine equivalents. This discovery prompts a critical reassessment of tramadol's therapeutic role, considering its multifaceted nature encompassing serotonergic effects and heightened fall risks. This study advocates for a nuanced and vigilant approach to tramadol prescription, cognizant of its potential risks and therapeutic implications, and highlights the imperative of optimizing data quality and traceability within electronic health records to enhance patient care and facilitate future research endeavors.

Substance Use and Anxiety About Pain Among Patients Seeking Abortion Services.

To evaluate how recent opioid, marijuana, and cannabidiol use affects pre-procedure pain-related anxiety for patients seeking abortion. We conducted a prospective, cross-sectional anonymous survey of patients seeking abortion assessing recent substance use and anxiety about pain during and after abortion. We compared substance users' and non-users' anxiety scores. Among 217 participants, recent opioid users (5.3%) had higher median anxiety scores for pain during (7.0 vs 6.0; p=0.33) and after (8.0 vs 6.0; p=0.01) abortion than non-opioid users. Anxiety scores were similar for marijuana and cannabidiol users. Assessing recent opioid use may help guide counseling for anxiety about abortion.

Pain control is comparable between opioid versus non-opioid management after otolaryngology procedures.

The current study aims to measure patient-reported satisfaction with pain control using opioid and non-opioid medications after undergoing the following otolaryngology procedures: parathyroidectomy, thyroid lobectomy, total thyroidectomy, and bilateral tonsillectomy. A prospective cohort study was performed at an academic medical center that included a telephone questionnaire and chart review. Opioid prescriptions, usage, and patient-reported pain outcomes were recorded. Bivariate analyses were used to compare opioid and non-opioid users. Of the 107 total patients undergoing otolaryngology procedures included in the study, 49 (45.8%) used an opioid for pain management postoperatively and 58 (54.2%) did not. Among the 81 patients who underwent endocrine procedures (parathyroidectomy, total thyroidectomy/lobectomy), most patients reported being "very satisfied" or "satisfied" with pain control whether they used opioids (n = 27/30, 90%) or not (n = 50/51, 98%). Of the 26 patients who underwent bilateral tonsillectomy, 19 (73%) were prescribed opioids and among these, most (n = 17/19, 89%) reported they were "very satisfied" or "satisfied" with pain control. In the non-opioid usage group, all patients (n = 7/7, 100%) reported they were "satisfied" with pain control. There was no statistically significant difference in patient-reported satisfaction with pain control between opioid and non-opioid users for any of the procedures listed. The results of our study suggest that patients who did not use opioids have a similar level of satisfaction with pain control compared to those using opioids after thyroid, parathyroid and tonsillectomy surgeries. Considering the magnitude of the opioid crisis, providers should reassess the need for opioid prescriptions following certain ENT procedures. IV.

Opioid use and subsequent delirium risk in patients with advanced cancer in palliative care: a multicenter registry study

The prevalent use of opioids for pain management in patients with advanced cancer underscores the need for research on their neuropsychiatric impacts, particularly delirium. Therefore, we aimed to investigate the potential association between opioid use and the risk of delirium in patients with advanced cancer admitted to the acute palliative care unit. We conducted a retrospective observational study utilizing a multicenter, patient-based registry cohort by collecting the data from January 1, 2019, to December 31, 2020, in South Korea. All data regarding exposures, outcomes, and covariates were obtained through retrospective chart reviews by a team of specialized medical professionals with expertise in oncology. Full unmatched and 1:1 propensity-score matched cohorts were formed, and stratification analysis was conducted. The primary outcome, delirium, was defined and diagnosed by the DSM-IV. Of the 2,066 patients with advanced cancer, we identified 42.8% (mean [SD] age, 64.4 [13.3] years; 60.8% male) non-opioid users and 57.2% (62.8 [12.5] years; 55.9% male) opioid users, respectively. Opioid use was significantly associated with an increased occurrence of delirium in patients with advanced cancer (OR, 2.02 [95% CI 1.22–3.35]). The risk of delirium in patients with advanced cancer showed increasing trends in a dose-dependent manner. High-dose opioid users showed an increased risk of delirium in patients with advanced cancer compared to non-opioid users (low-dose user: OR, 2.21 [95% CI 1.27–3.84]; high-dose user: OR, 5.75 [95% CI 2.81–11.77]; ratio of OR, 2.60 [95% CI 1.05–6.44]). Patients with old age, male sex, absence of chemotherapy during hospitalization, and non-obese status were more susceptible to increased risk of delirium in patients with cancer. In this multicenter patient-based registry cohort study, we found a significant, dose-dependent association between opioid use and increased risk of delirium in patients with advanced cancer. We also identified specific patient groups more susceptible to delirium. These findings highlight the importance of opioid prescription in these patients with advanced cancer, balancing effective doses for pain management and adverse dose-inducing delirium.

Does preoperative opioid use predict outcomes to 6 months following primary unilateral knee or hip arthroplasty for osteoarthritis? A data-linked retrospective study

BackgroundFew Australian studies have examined the incidence of prescribed opioid use prior to primary total knee or total hip arthroplasty (TKA, THA) and whether it predicts post-surgery outcomes. A recent Australian study demonstrated that the prevalence of pre-arthroplasty opioid use was approximately 16%. In the United States, approximately 24% of people undergoing TKA or THA are chronic opioid users preoperatively.PurposeThis study aimed to determine (i) the proportion of TKA and THA patients who use prescribed opioids regularly (daily) before surgery (i.e., opioid use reported between the time of waitlisting and any time up to 3 months before surgery), (ii) if opioid use before surgery predicts (a) complication/readmission rates to 6-months post-surgery, and (b) patient-reported outcomes to 6-months post-surgery.MethodsA retrospective cohort study of patients who underwent TKA or THA between January 2013 and June 2018 from two Australian public hospitals was undertaken utilizing linked individual patient-level data from two prospectively collected independent databases comprising approximately 3,500 and 9,500 people (database contained known opioid usage data within the 5-year time frame). Inclusion criteria included (i) primary diagnosis of osteoarthritis of the index joint, (ii) primary elective THA or TKA, and (iii) age ≥ 18 years. Exclusion criteria included (i) revision arthroplasty, (ii) non-elective arthroplasty, (iii) hip hemiarthroplasty, (iv) uni-compartmental knee arthroplasty, and (v) previous unilateral high tibial osteotomy.ResultsAnalysis was completed on 1,187 study participants (64% female, 69% TKA, mean (SD) age 67 [9.9]). 30% were using regular opioids preoperatively. Adjusted regression analyses controlling for multiple co-variates indicated no significant association between preoperative opioid use and complications/readmission rates or patient-reported outcomes to 6 months post-surgery. Model diagnostics produced poor discrimination for area under the curves and non-significant goodness of fit tests. Pre-arthroplasty opioid use was associated with lower health-related quality of life (EuroQol-Visual Analogue Scale) compared to non-opioid users undergoing primary THA (mean difference -5.04 [-9.87, -0.22], P = 0.04, Adjusted R2 = 0.06)ConclusionIn this study, 30% of patients were using prescribed opioids daily prior to primary TKA or THA. Pre-arthroplasty opioid use was not associated with postoperative adverse events or patient-reported pain, function, or global perceived improvement up to six months post-surgery.

Reductions in sustained prescription opioid use within the US between 2017 and 2021

Over the last decade, various efforts have been made to curtail the opioid crisis. The impact of these efforts, since the onset of the COVID-19 pandemic, has not been well characterized. We sought to develop national estimates of the prevalence of sustained prescription opioid use for a time period spanning the COVID-19 pandemic (2017–2021). We used TRICARE claims data (fiscal year 2017–2021) to identify patients who were prescription opioid non-users prior to receipt of a new opioid medication. We evaluated eligible patients for subsequent sustained prescription opioid use. The prevalence of sustained prescription opioid use during 2020–2021 was compared to 2017–2019. We performed multivariable logistic regression analyses to adjust for confounding. We performed secondary analyses that accounted for interactions between the time period and age, as well as a proxy for socioeconomic status. We determined there was a 68% reduction in the odds of sustained prescription opioid use (OR 0.32; 95% CI 0.27, 0.38; p < 0.001) in 2020–2021 as compared to 2017–2019. Significant reductions were identified across all US census divisions and all patient age groups. In both time periods, the plurality of encounters associated with initial receipt of an opioid that culminated in sustained prescription opioid use were associated with non-specific primary diagnoses. We found significant reductions in sustained prescription opioid use in 2020–2021 as compared to 2017–2019. The persistence of prescribing behaviors that result in issue of opioids for poorly characterized conditions remains an area of concern.

Effectiveness of Long-Term Opioid Therapy for Chronic Low Back Pain.

Clinical trials generally have not assessed efficacy of long-term opioid therapy (LTOT) beyond 6 months because of methodological barriers and ethical concerns. We aimed to measure the effectiveness of LTOT for up to 12 months. We conducted a retrospective cohort study among adults with chronic low back pain (CLBP) from April 2016 through August 2022. Participants reporting LTOT (>90 days) were matched to opioid nonusers with propensity scores. Primary outcomes involved low back pain intensity, back-related disability, and pain impact measured with a numerical rating scale, the Roland-Morris Disability Questionnaire, and the Patient-Reported Outcomes Measurement Information System, respectively. Secondary outcomes involved minimally important changes in primary outcomes. The mean age of 402 matched participants was 55.4 years (S.D., 11.9 years), and 297 (73.9%) were female. There were 119 (59.2%) LTOT users who took opioids continuously for 12 months. The mean daily morphine milligram equivalent dosage at baseline was 36.7 (95% CI, 32.8 to 40.7). There were no differences between LTOT and control groups in mean pain intensity (6.06, 95% CI, 5.80-6.32 vs 5.92, 95% CI, 5.68-6.17), back-related disability (15.32, 95% CI, 14.55-16.09 vs 14.81, 95% CI, 13.99-15.62), or pain impact (32.51, 95% CI, 31.33-33.70 vs 31.22, 95% CI, 30.00 to 32.43). Correspondingly, LTOT users did not report greater likelihood of minimally important changes in any outcome. Using LTOT for up to 12 months is not more effective in improving CLBP outcomes than treatment without opioids. Clinicians should consider tapering opioid dosage among LTOT users in accordance with clinical practice guidelines.

Do FIQR Severity Categories and Symptoms, Differentiate Between Continuous, Intermittent and Non-Opioid Users in the Treatment of Fibromyalgia?

BackgroundMany fibromyalgia patients utilize opioids to treat symptoms. It is important to better understand nuances regarding this treatment option and any stigma associated with this treatment modality. AimThis study: (1) assessed the prevalence of opioid use among continuous, intermittent, and non-opioid users in fibromyalgia patients; (2) determined whether the Revised Fibromyalgia Impact Questionnaire (FIQR) was useful in distinguishing opioid use and symptom burden; and (3) assessed whether fibromyalgia patients encountered stigma and/or invalidation. DesignA cross-sectional, observational study of 1,105 participants’ responses to validated fibromyalgia and invalidation scales and demographic questions. MethodsThe study employed online survey methodology. ResultsA total of 45% of patients reported utilizing opioids (27% continuous, 18% intermittent, 55% non-users). FIQR disease categories (mild to most severe) strongly distinguished between opioid and non-opioid users with 59% of users falling in the most severe category and 68% of non-users falling in mild disease category (p < .0001). Interestingly, intermittent users were similar to non-users on FIQR severity (65.9 versus 65.7; p <0.60, 0-100) while continuous users reported greater severity than the former (73.9, p < .0001). Continuous users particularly reported more problems with daily activities (p < .0001), being overwhelmed (p < .0001), and being unable to accomplish goals (p < .0001). Stigma related to being ‘drug seeking’ and being ‘judged’. Invalidation was infrequent. ConclusionsOpioid use is common in fibromyalgia and increases monotonically with FIQR severity. Multidisciplinary approaches which help patients perform daily activities, decrease feelings of overwhelm, accomplish goals, and reduce stigma may be beneficial.

Fall-related Injuries and Opioid Administration Among Veterans With Dementia in US Department of Veterans Affairs Community Living Centers.

Opioid use is associated with fall-related injuries (FRI) among older adults, especially those with dementia. We examined FRI following changes in national opioid safety initiatives over 3 regulatory periods [preinitiatives baseline (period 1): October 2012 to June 2013; post-Veteran Affairs (VA) opioid safety initiative (period 2): January 2014 to November 2015; post-VA and CDC opioid prescribing guidelines (period 3): March 2017 to September 2018] among Department of VA Community Living Center (CLC) long-stay residents with dementia. VA provided and purchased care records, Medicare claims, CLC Minimum Data Set (MDS) assessments. VA bar-code medication administration data, VA outpatient prescription refill data, and Medicare Part D data were used to capture medication from inpatient, outpatient, and Medicare sources. A total of 12,229 long-stay CLC residents with dementia between October 2012 and September 2018. We applied Veteran-regulatory period level (1) generalized linear model to examine the unadjusted and adjusted trends of FRI, and (2) difference-in-difference model with propensity score weighting to examine the relationship between opioid safety initiatives and FRI in 3 regulatory periods. We applied propensity score weighting to enable the cohorts in periods 2 and 3 had similar indications for opioid administration as in period 1. FRI prevalence per month among CLC residents with Alzheimer disease and related dementias decreased from 3.1% in period 1 to 1.6% and 1.2% in periods 2 and 3, and the adjusted probability of FRI was 17% and 40% lower in periods 2 and 3 compared with period 1. The any, incident, and continued opioid administration were significantly associated with higher FRI, whereas the differences in FRI probabilities between opioid and nonopioid users had no significant changes over the 3 regulatory periods. FRI was reduced among CLC residents with Alzheimer disease and related dementias receiving care in VA CLCs over the 3 regulatory periods, but the FRI reduction was not significantly associated with opioid safety initiatives. Other interventions that potentially targeted falls are likely to have helped reduce these fall events. Future studies could examine whether opioid use reduction ultimately benefitted nursing home residents by focusing on other possible outcomes or whether such reduction only resulted in more untreated pain.

Females Are More Likely Than Males to Fill an Opioid Prescription in the Year After Anterior Cruciate Ligament Reconstruction

To report rates of preoperative and postoperative opioid use between male and female patients and to identify risk factors for extended opioid use following anterior cruciate ligament reconstruction (ACLR). Patients undergoing ACLR between 2011 and 2018 were identified from the PearlDiver database. The opioid refill rates for males vs females were compared at monthly intervals for 1 year after ACLR. Patients who filled an opioid prescription <3 months before surgery were classified as opioid users, while those who had never filled one were classified as nonopioid users. Of 106,995 ACLR patients, 37,890 (35.4%) were opioid users <3 months before surgery, and 37,554 (35.1%) had never filled an opioid prescription. Of the preoperative opioid users, 20,413 (53.9%) were female and 17,477 (46.1%) were male (P < .001). Postoperatively, females were at higher risk of filling an opioid prescription at each monthly interval, except for the first month after surgery. The refill rate for opioid users was also higher than that for nonopioid users at each monthly interval after ACLR. In addition to patient sex, a preoperative diagnosis of anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use increased a patient's risk of filling an opioid prescription postoperatively. This study demonstrated that females are significantly more likely to be opioid users than males prior to ACLR and are more likely to continue to refill an opioid prescription in the year following surgery. Multiple risk factors were associated with prolonged postoperative opioid utilization, including female sex, anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use. Level III, retrospective cohort study.

EE482 Public, Private, and Out-of-Pocket Spending Comparisons between Opioid and Non-Opioid Users, 2008-2019

To compare Public, Private, and Out-of-pocket healthcare spending among opioid and non-opioid users.

Chronic opioid use is associated with higher flu vaccine induced Ab response in HIV+ and HIV− individuals.

Abstract Opioid dependence is frequent in people with HIV (PWH), but impact of opioids on immune system of PWH is unknown. This study tested the hypothesis that chronic opioid use exacerbates known impairment of flu vaccine responses in PWH. Chronic opioid users were compared to non-opioid users in HIV+ and HIV− groups termed HIV+OP+ (n=28), HIV-OP+ (n=55), HIV+OP− (n=53), HIV-OP− (controls, n=58). HIV+ individuals were on ART with plasma virus load &amp;lt;200 copies/mL. Flu antibody titers were determined at pre- (T0) and 4 weeks post (T2) seasonal quadrivalent influenza vaccinations (2020–2022) by hemagglutination inhibition (HAI) along with a plasma cytokine score at T0. Vaccine response (VR) was defined as a 4-fold change (FC) in titer from T0 to T2. In Kruskal Wallis analysis, all 4 groups had increases in HAI titer from T0 to T2 (p&amp;lt;0.01 to p&amp;lt;0.0001) for antigens (H1N1, H3N2, B Victoria) and whole vaccine. HIV+ status was associated with decreased responses to all antigens but OP+ status in HIV+ and HIV− had higher response than HIV+OP−, both in T2/T0 FC and T2 titer for one or more vaccine antigens (p&amp;lt;0.05 to p&amp;lt;0.001). In regression analysis controlling for demographics, opioid use was associated with increased response to H1N1 and B Yamagata antigens. In a random forest model, predicted probability of VR was lower for HIV+ status and higher for OP+ status. Cytokine score was highest in HIV+OP+. Results of quantitative Ab response to flu vaccine refute our hypothesis that flu vaccine response would be impaired in PWH who chronically use opioids. Qualitative assessments of Ab and mechanism of opioid intersection with B cell function are ongoing to understand if opioid use overcomes humoral immune deficits in PWH.

Preadmission Opioid Use and 1-Year Mortality Following Incident Myocardial Infarction: A Danish Population-Based Cohort Study (1997-2016).

Background Opioid use has been linked to an increased risk of myocardial infarction and cardiovascular mortality, but the prognostic impact of opioid use before an incident myocardial infarction is largely unknown. Methods and Results We conducted a nationwide population-based cohort study including all patients hospitalized for an incident myocardial infarction in Denmark (1997-2016). Based on their last redeemed opioid prescription before admission, patients were categorized as current users (0-30 days), recent users (31-365 days), former users (>365 days), and nonusers. One-year all-cause mortality was calculated using the Kaplan-Meier method. Hazard ratios (HRs) were computed using Cox proportional hazards regression analyses, adjusting for age, sex, comorbidity, any preceding surgery within 6 months before the myocardial infarction admission, and medication use before the myocardial infarction admission. We identified 162 861 patients with an incident myocardial infarction. Of these, 8% were current opioid users, 10% were recent opioid users, 24% were former opioid users, and 58% were nonusers of opioids. One-year mortality was highest among current users (42.5% [95% CI, 41.7%-43.3%]) and lowest among nonusers (20.5% [95% CI, 20.2%-20.7%]). Compared with nonusers, current users had an elevated 1-year all-cause mortality risk (adjusted HR, 1.26 [95% CI, 1.22-1.30]). Following adjustment, neither recent users nor former users of opioids were at elevated risk. Conclusions Preadmission opioid use was associated with an increased 1-year all-cause mortality risk following an incident myocardial infarction. Opioid users thus represent a high-risk subgroup of patients with myocardial infarction.

Does Opioid Addiction Influence Clinical and Angiographic Outcomes in STEMI Patients Undergoing Emergency PCI?

Despite recognizing the traditional coronary artery disease (CAD) risk factors, some secondary factors, such as opioid substance abuse, have to be considered. We aimed to assess the relationship between opioid consumption and emergency percutaneous coronary intervention (PCI) revascularization results, according to Thrombolysis in Myocardial Infarction (TIMI) flow and in-hospital survival outcomes in ST-elevation myocardial infarction (STEMI) patients. This case-control study was conducted on 186 patients (93 patients in each group) with acute STEMI, who were referred to Chamran Heart Center, Isfahan, Iran. Opioid addiction was diagnosed by patients' records and confirmed by conducting an interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. Patients in both groups were evaluated and compared for angioplasty results based on the TIMI flow grade and in-hospital cardiovascular events and complications. Ninety-one patients (97.84%) of each group were male, and opioid-addicted patients were younger than the non-opioid users (52.95 9.91 vs. 57.90 12.17, P = 0.003). Among the CAD risk factors, prevalence of dyslipidemia was significantly higher in non-opioid users, whereas cigarette smoking was higher in opioid-addicted patients (P < 0.050). There was no significant difference between the two groups regarding pre- and post-procedural myocardial infarction complications as well as mortality rate (P > 0.050). Also, there were no significant differences between the opioid and non-opioid users regarding TIMI flow grading, and successful PCI rate based on achieving TIMI III was 60.21% versus 59.1% in opiate-dependent and non-opioid users, respectively (P = 0.621). Opioid addiction has no effects on post-PCI angiographic results and in-hospital survival outcomes in STEMI patients which undergoing emergency PCI.

CONTINUED OPIOID USE REDUCES PERCEIVED CHANCE OF LIVING TO AGE 75 AMONG YOUNG-OLD INDIVIDUALS WITH CHRONIC PAIN

Abstract Pain limits older adults’ predictions of their own life expectancies. Due to their analgesic properties and simultaneous linkages to depression, poor subjective health, and functional disability, it is uncertain if the use of opioids augments or contributes to limitations in subjective life expectancy (SLE). This study uses 2016 and 2018 data from the Health and Retirement study to assess the predictive value of prescription opioid use transitions on perceived chances of living to age 75 (SLE). Our sample includes 50 to 62 year-olds who reported pain in both waves (N=1,977). The OLS model controls for pain intensity and activity interference, socio-demographic factors, six chronic conditions, depression, and the 2016 baseline outcome measure. Relative to non-opioid users, respondents who transitioned off of opioids after 2016 reported significantly higher SLEs in 2018 (b=5.56, p=.05). Respondents who used opioids in both waves reported significantly lower SLEs relative to non-opioid users (b=-4.17, p=.02). Individuals who began using opioids following the 2016 wave were no different on SLE than non-opioid users (p=.11). Higher 2016 SLE predictions and being female were associated with higher SLEs. Being never married and ever having diabetes were negatively associated with SLE. Continued opioid use among individuals with chronic pain reduced anticipated chances of living to 75 whereas transitioning off of such medications had the opposite effect. Despite their analgesic properties, prescribed opioid use has negative effects on future outlook independent of pain, health status, and depression. As a consequence, continued opioid users may poor health and/or financial planning decisions.

Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today?

BackgroundThe opioid epidemic in the US has led prescribers to reevaluate postoperative pain control particularly in the field of spine surgery, where postoperative analgesia requirements and consumption have historically been high. There is a need to mitigate the quantity of unused pills after surgery by adjusting prescribing practices. Achieving the balance of pain control after surgery without overprescribing opioids may be accomplished by developing a modified approach to prescribing practices; however, there is a need to first understand the opioid requirements of the modern spine surgery patient with respect to their elective spine surgery. Therefore, the primary aim of this study was to determine the percentage of opioids not utilized at 90-days after elective spine surgery. Secondary aims were to identify differences in the percentage of unused opioids between surgical subgroups and preoperative opioid status, to determine factors associated with opioid utilization, and to estimate the distribution of opioids consumed to control pain up to the 90th percentile in each surgical subgroup. MethodsIn this prospective, observational cohort study, adults undergoing elective spine surgery at a multi-surgeon, single center were prospectively enrolled and divided into subgroups: anterior cervical, lumbar decompression, and short-segment lumbar fusion. Prescribed MMEs were identified from prescriptions, consumed MMEs were obtained from pill counts, and the percent leftover was calculated. Distributions of MMEs consumed were analyzed to compare utilization between preoperative opioid users or non-users within each surgical subgroup. ResultsOf 117 patients, 41.9% were preoperative opioid users. The percentage of unused opioids by surgical subgroup was: 45.4% cervical, 57.3% lumbar decompression, and 37.4% lumbar fusion (p=0.066). The percentage of unused opioids by preoperative opioid exposure was greater in the opioid non-users (58.0%) than users (28.4%, p<0.001)). Regression analysis showed that surgical subgroup and preoperative opioid exposure were associated with leftover opioids. ConclusionsAt 90-days, the percentage of unused opioids was over 45% in this cohort of elective spine surgery patients and was nearly double in the group without preoperative opioid exposure. These results suggest the modern elective spine surgery patient is using less opioids than prescribed, supporting the conclusion that the number of MMEs prescribed can be reduced to minimize quantities of leftover pills available for diversion, without sacrificing the priority of appropriate postoperative pain control.

Chronic Opioid Use Is Highly Prevalent and Associated with Inferior Survival in Myeloma Patients in Remission after Autologous Transplant

Overuse of opioid analgesics has been associated with a significant public health crisis, but at the same time, these medications are critical as an adjunctive treatment for bone pain in multiple myeloma (MM). Despite this, opioid use patterns in MM have not been well studied. Given the prolonged survival after autologous stem cell transplant (ASCT) and maintenance therapy, the effect of chronic opioid use (COU) on outcomes in these patients has become an important area to address. We aimed to describe COU in our ASCT cohort and its impact on long-term outcomes. Adult patients ≥ 18 years (n=174) with MM who received ASCT between 2012 and 2019 at an urban medical center were included. COU was defined as having an active prescription for 3 consecutive months. Daily opioid doses were converted to morphine milligram milliequivalents (MME) using standard conversion factors (MME ≥ 20 mg/day has been correlated with risk for overdose events). A Poisson regression analysis including factors such as education level, alcohol, and illicit drug, use of non-opioid analgesics, and employment status, was performed to identify predictors of COU at baseline and 6 months after ASCT. Landmark OS and PFS analysis were performed at 6 months after ASCT to assess the impact of ongoing COU. A multivariate Cox proportional hazards ratio model adjusted for known prognostic factors was performed to identify predictors of OS. The median age was 59 (29-78) years, 90 (51.7%) were male, 105 (60%) were Black, 24 (13.8%) were Hispanic, and 23 (13.2%) were White. At diagnosis, 111 (63.8%) patents were found to have IMWG-defined bone disease and 45 (25.9%) patients experienced a myeloma-related fracture. At baseline (time of ASCT), COU was observed in 92 (52.9%) patients, 27 (29.3%) of whom did not have prior history of bone disease. The baseline average MME/day in the entire cohort was 65.3 mg (±70.0). Both COU rates (52.4% vs. 54%, p=0.98) and average MME/day (69.5 versus 55.2 mg; p=0.37) were similar in those with and without bone disease. In Poisson regression analysis, previous illicit drug use was associated with a higher baseline COU (RR 4.07, 95% CI 1.53-10.82; p=0.005). The use of non-opioid analgesic drugs (RR .024, 95% CI 0.09-0.63, p=0.004), being retired (RR 0.49, 95% CI 0.29-0.83; p=0.008), or employed (RR 0.37, 95% CI 0.15-0.91; p=0.031) were associated with lower baseline COU. Presence of bony disease was not associated with baseline COU (RR 1.11, 95% CI 0.78-1.58; p=0.569). In the entire cohort, 142 (81.6%) patients received opioids during ASCT admission, while 105 (60.3%) were discharged on opioids and 72 (41.4%) had COU at 6 months after ASCT. Documented reasons for being discharged on opioids were presence of musculoskeletal (n=38, 45.8%), generalized (n=16, 19.3%), neuropathic (n=12), residual mucositis-related (n=11, 14.5%), and headache-related (n=6, 7.2%) pain. In baseline non-opioid users, 30 (36.6%) patients became new opioid users on discharge, and of these 13 (15.9%) remained on opioids at 6 months. Opioid use at hospital discharge was associated with higher COU at 6 months (RR 4.21, 95% CI 1.46-12.11; p=0.008). Indicators of disease burden, including bony lesions, were not associated with 6 month COU. 6-month MME/day was found to be relatively high at an average of 47.51 (±75.96) mg. Although PFS was not different, OS was significantly worse in patients with COU at 6 months (48 months versus undefined, p=0.004; Figure 1) and in a multivariate model, we found that COU at 6 months strongly predicted for worse overall survival (HR 6.71, 95% CI 1.73-26.09; p=0.006). Here we describe patterns of COU among MM patients undergoing ASCT, and in particular in long term survivors. We demonstrate high rates of baseline COU not related to the presence of bone disease. We highlight a high rate of opiate use on discharge including a number of new users after ASCT, which result in ongoing COU at 6 months. We show the negative impact of COU at 6 months on OS but not PFS suggesting that opioid-related morbidity may play a role. Finally, we demonstrate that MME/day throughout disease course is relatively high. These data highlight the need to improve understanding and management of pain in MM. Non-opioid analgesic use correlated with lower risk of COU and may be appropriate in managing pain effectively and safely. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Opioid administered prior to onset of myocardial infarction is associated with atypical symptoms of acute coronary ischemia in emergency calls

Abstract Background Acute identification and treatment of myocardial infarction (MI) is crucial for survival. MI symptom presentation is typically characterized by chest pain. Regular use of opioids to relief pain of chronic diseases is common. However, it has not been investigated whether opioid administered prior to onset of MI is associated more with atypical presentation of ischemia compared to non-opioid users. Purpose To investigate if opioid therapy is associated with atypical symptoms of MI. Methods The study is registry-based. MI is defined as patients with the ICD-10 discharge diagnoses I20.0 and I21 as primary diagnosis &amp;lt;24 hours after a call to the Capital Emergency Medical Services, including the Emergency Number (1–1-2) and Out-of-hours Service (OOHS). MI patients with opioid treatment prior to onset of MI are compared with a control group of MI patients without opioid treatment. The primary symptom of MI is registered in calls to the Capital Emergency Medical Services, from 2014 to 2018. Opioid treatment includes opioid prescribed and picked up &amp;lt;30 days prior to onset of MI. Results In total, 866 MI patients with opioid treatment and 10,061 MI patients without opioid treatment were included. The median age was 72.0 vs 67.8 years, 50.5% vs 34.5% were women, 61.0% vs 54.7% called the Emergency Number (1–1-2), ischemic heart disease was present in 48.5% vs 34.3% and type 2 diabetes in 23.1% vs. 16.2%. Atypical symptoms of MI were associated with opioid treatment and most prevalent in calls to OOHS, in women and by higher age. Acute symptoms of MI are visualized in Figure 1 and 2. Conclusion Opioid treatment prior to onset of MI was associated with increased atypical symptoms of MI, especially dyspnea, and increased in calls to the OOHS, in women and by higher age. This might challenge the clinician in early diagnose of MI in patients with opioid treatment and thereby delay acute lifesaving treatment. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation