New Opioid Use High Among Older Adults With COPD

New opioid use was high among older people with chronic obstructive pulmonary disease (COPD) in community-dwelling adults and residents of long-term care facilities in Ontario, Canada, according to a study in the British Journal of Clinical Pharmacology.

Nicholas T. Vozoris, BSc, MHSc, MD, FRCPC, of St. Michael’s Hospital in Toronto, and colleagues said potential safety concerns are raised by the degree and pattern of new opioid use in this older and respiratory-vulnerable population. They also noted that several patterns potentially indicative of excessive opioid use were seen among older adults with COPD—especially among frailer long-term care residents.

The study followed 107,109 community-dwelling and 16,207 long-term care resident older adults with physician-diagnosed COPD from 2003 to 2012. During the observation period, 68.1% of community-dwelling and 54.4% of long-term care residents received an incident opioid drug. The investigators found patterns of new opioid use among older adults with COPD that have the potential to augment possible negative drug-related effects including multiple opioid dispensing (8.8%), dispensing for more than 30 days’ duration (up to 19.8%), second dispensing (35%-43%), and early refills (24.2%) were observed.

Incident opioid dispensing was also reported to occur during COPD exacerbations (6.9% among all long-term care residents; 18.1% among long-term care residents with frequent exacerbations). The same patterns of incident opioid use occurred among community-dwelling individuals but with lower frequencies, the study reported.

The majority of new opioid use during exacerbations occurred either on the day of hospital presentation or discharge or in the days following hospital discharge.

“Therefore, drug reconciliation during hospitalization may be a key process for optimizing opioid drug use in this population,” the investigators said. “The majority of opioid prescriptions in the present study population originated from family physicians, suggesting that they may play an important role in optimizing opioid drug use as well.”

Opioid prescribing for COPD patients might reflect physician intention to use multi-modal analgesic therapy to treat chronic musculoskeletal pain, a common problem in COPD, the investigators said, but they noted that several recent Cochrane reviews have concluded that there is minimal good-quality evidence supporting opioids as an effective treatment for chronic musculoskeletal pain. Further study is needed to assess potential respiratory-related health outcomes of opioid use among older adults with COPD.