TY - JOUR
T1 - Opioid prescribing and risk of drug-opioid interactions in older discharged patients with polypharmacy in Australia
AU - Al-Qurain, Aymen Ali
AU - Gebremichael, Lemlem G.
AU - Khan, Mohammed S.
AU - Williams, Desmond B.
AU - Mackenzie, Lorraine
AU - Phillips, Craig
AU - Russell, Patrick
AU - Roberts, Michael S.
AU - Wiese, Michael D.
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - Adverse drug reactions
KW - Chronic non-cancer pain
KW - Drug–drug interaction
KW - Medications use
KW - Older
KW - Opioids
KW - Polypharmacy
UR - http://www.scopus.com/inward/record.url?scp=85096342565&partnerID=8YFLogxK
U2 - 10.1007/s11096-020-01191-1
DO - 10.1007/s11096-020-01191-1
M3 - Article
C2 - 33206289
AN - SCOPUS:85096342565
SN - 2210-7703
VL - 43
SP - 365
EP - 374
JO - International Journal of Clinical Pharmacy
JF - International Journal of Clinical Pharmacy
IS - 2
ER -
