Opioid prescribing and risk of drug-opioid interactions in older discharged patients with polypharmacy in Australia

Aymen Ali Al-Qurain, Lemlem G. Gebremichael, Mohammed S. Khan, Desmond B. Williams, Lorraine Mackenzie, Craig Phillips, Patrick Russell, Michael S. Roberts, Michael D. Wiese

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background Opioids are commonly prescribed to managing chronic pain in older persons. However, these patients are often at risk of drug-opioid interactions due to polypharmacy. Objectives To identify the prevalence of opioid prescribing and drug-opioid interactions in poly-medicated older patients and factors associated with opioid prescribing. Setting Patients were included if they were admitted to the Royal Adelaide Hospital between September 2015 and August 2016, aged ≥ 75 years and took ≥ 5 medications at discharge. Methods After ethics approval, data of were retrospectively collected from case notes. The Charlson Comorbidity Index and Drug Burden Index were determined and opioids were classified as strong or weak. The association between opioid use and concurrent medications was computed using logistic regression and the results presented as odds ratios (OR) and 95% confidence intervals (95% CI), adjusted for age, sex, Charlson Comorbidity Index, number of prescribed medications and modified-Drug Burden Index. Main outcome measure Association between concurrent medications and opioid prescribing. Results 15,000 geriatric admissions were identified, of which 1192 were included. A total of 283 (23.7%) patients were prescribed opioids, with oxycodone accounting for 56% of these prescriptions. Opioid users were prescribed more medications (11.2 vs. 9.0, P < 0.001) and had higher Drug Burden Index (1.2 vs. 0.14, P < 0.001) compared to non-users. Opioid use was associated with concurrent prescription of antiepileptics (OR = 1.7, 95% CI 1.1–2.6), and negatively associated with Charlson Comorbidity Index (OR = 0.9, 95% CI 0.8–0.98) and concurrent use of antipsychotics (OR = 0.5, 95% CI 0.3–0.9) and beta blocking agents (OR = 0.4, 95% CI 0.3–0.6). Conclusions Strong opioids were prescribed more often than weak opioids and opioid users presented with characteristics and concurrent medications which increased the risk of opioid related adverse drug effects.

Original languageEnglish
Pages (from-to)365-374
Number of pages10
JournalInternational Journal of Clinical Pharmacy
Volume43
Issue number2
DOIs
Publication statusPublished - Apr 2021
Externally publishedYes

Keywords

  • Adverse drug reactions
  • Chronic non-cancer pain
  • Drug–drug interaction
  • Medications use
  • Older
  • Opioids
  • Polypharmacy

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