Association Between Prescription Opioid Use and Mortality in Community-Dwelling Older Adults

Abstract

Prescription opioid use is concerning among older adults. Yet, few studies have examined the impact of opioid use on mortality by considering multimorbidity. Our sample includes 1586 older adults aged ≥65 recruited in primary care from 2011-2013 in a large health administrative region in Quebec and participating in the ESA-Services study, a longitudinal study on aging and health service use. An opioid prescription delivered in the 3 years prior to the baseline interview was identified using the provincial pharmaceutical drug registry. Mortality was ascertained from the vital statistics registry until 2015. The presence of chronic diseases was based on self-reported and physician diagnostic codes in health administrative databases. Physical multimorbidity was defined as ≥3 chronic physical conditions from either source. Physical/psychiatric multimorbidity was defined as ≥3 chronic physical conditions and ≥1 common mental disorder from either source. Logistic regression analyses were conducted to examine the association between opioid use and mortality, controlling for sociodemographic factors. Interactions were tested for opioid use and multimorbidity. Older adults with physical multimorbidity using opioids were 1.76 (95%CI: 1.02-3.03) times more likely to die than those not using opioids. Those with physical/psychiatric multimorbidity using opioids were 2.27 (95%CI: 1.26-4.09) times more likely to die than those not using opioids. Older age, male sex, and single marital status significantly increased the risk of mortality. Overall, opioid use increases the risk of death in older adults with multimorbidity. The presence of mental disorders further increases the risk of death in older adults with physical multimorbidity using opioids.

Mortality and health-related quality of life in older adults with long-term use of opioids, z-hypnotics or benzodiazepines: a prospective observational study at 5 years follow-up

“…This agrees with the findings of other reported studies, which have found similar results with increased risk of all-cause mortality. [18][19][20][21][22] In the bivariate Cox regression, we found that higher age, reduced cognitive function and disease burden were significantly associated along with being a CNSD user. Disease burden, reduced cognitive function and CNSD use are all factors that may be an expression of disease/ reduction in health, but in the multivariable analysis, adjusting for relevant covariates, we found only higher age and male sex to be factors associated with higher risk of mortality.…”

“…This agrees with the findings of other reported studies, which have found similar results with increased risk of all-cause mortality. 18–22 …”

“…But it is well documented that medication groups such as the opioids, z-hypnotics, benzodiazepines that are known to have a range of potentially severe side effects, sometimes cause injuries and disease 6 11-14 as well as increased risk of mortality. [18][19][20][21][22] This is particularly so in older adults and with long-term use of such medications. 1 2 Pain, sleep disturbance and anxiety may be symptoms of a range of diseases.…”

“…[15][16][17] Finally, these medications are, either on their own or in combination with each other, associated with increased risk of all-cause mortality. [18][19][20][21][22][23][24][25]…”