Concomitant use of benzodiazepines and opioids in community‐dwelling older people with or without Alzheimer's disease—A nationwide register‐based study in Finland

Abstract

Objective The study aims to determine the prevalence of concomitant use of benzodiazepines and opioids among community‐dwelling older people with or without Alzheimer's disease (AD). An additional aim was to describe the factors associated with prolonged concomitant use, and the most commonly used combinations of these drugs. Methods This study utilized data from the register‐based Medication Use and Alzheimer's disease (MEDALZ) study, including all community‐dwelling residents of Finland who received a clinically verified AD diagnosis between 2005 and 2011 (n = 70 718) and their matched comparison persons without AD. After exclusion of individuals who were hospitalized throughout the follow‐up, 69 353 persons with and 69 353 without AD were included in this study. Results Benzodiazepines and related drugs (BZDRs) were used by 28 475 (41.1%) of those with and 24 506 (35.3%) of those without AD. Prolonged (greater than or equal to 90 days) concomitant use of BZDRs and opioids was more common among BZDR users without AD (N = 3936; 16.1%) than among those with AD (N = 2963; 10.4%). A shorter duration of concomitant use (1‐89 days) revealed similar results, N = 3821; 15.6% and N = 3008; 10.6%, respectively. Prolonged concomitant use of BZDRs and opioids was associated with female sex, low socioeconomic position, most of the common comorbidities and history of substance abuse or long‐term benzodiazepine use. The most commonly used combinations were Z‐drug (31.7%) or benzodiazepine (29.9%) with a weak opioid. Conclusions Despite the recommendations and risks, the prevalence of concomitant BZDR and opioid use was common in older persons with or without AD. It is important to develop strategies to reduce unnecessary concomitant use of these drugs.

Opioids and Falls Risk in Older Adults: A Narrative Review

“…Concomitant alcohol use further increases the risk. However, concomitant use of opioids and benzodiazepines appears to exist, and extensive sedation further increased the risk of falls [43]. Although older adults might have both severe nociceptive and neuropathic pain, concomitant use of opioids and gabapentinoids (gabapentin and pregabalin) should be avoided due to the increased sedation [18].…”

Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia

“…While the use of psychotropics in ADRD is controversial due to concerns over safety associated with these drugs [37], antipsychotics are indicated for aggression and psychosis and antidepressants are for major Proportion difference between ADRD and non-ADRD groups was estimated with generalized linear models along with weight statement (to incorporate inverse probability weighting that balances differences in baseline characteristics between the ADRD and non-ADRD groups) c CNS-active drugs included antipsychotics, benzodiazepine, nonbenzodiazepine or hypnotics, tricyclic antidepressants, and SNRIs d Defined as having at least 1 quarterly MDS 3.0 pain assessment with a numeric rating scale score of 4 or more, or moderate or severe pain based on a verbal descriptor scale e Measured as having at least 1 quarterly MDS 3.0 moderate to severe pain score without prescription opioids dispensed within 30 days before and after the MDS 3.0 pain assessment f Measured as having at least 1 quarterly MDS 3.0 moderate to severe pain score that had no scheduled pain medications (assessed in MDS 3.0 Section J) depression and anxiety. Literature has documented the safety of concurrent use of opioids and benzodiazepines in older populations with or without ADRD [38][39][40]. However, to our best knowledge, no population-based studies have examined benefits and harms associated with concurrent use of opioids and antipsychotics or antidepressants, the most common drug combination in patients with ADRD observed by the present study.…”

Factors associated with potentially inappropriate opioid use in community‐living older adults consulting in primary care

“…18 Sociodemographic factors such as age, 11,13,14,16,19,20 Caucasian ethnicity, 13,14,18,20 and lower socioeconomic status 13,16,20,21 were significantly associated with PIOU in older adults. Studies also report that pain presence/intensity, 13,14,17,20,21 alcohol use 17 or use disorder, 11 history of substance abuse, 13,16,17,20 and higher health services utilization 17,18 increased the risk of PIOU.…”

“…Studies consistently show that older women are at increased risk of PIOU compared to men 11,13–20 . In general and veteran population studies, physical 15,16,18,20,21 and mental disorder comorbidities 16,17,19,20,22 have been associated with an increased risk of PIOU, except for one study showing a protective effect in those with two or more psychiatric comorbidities 18 . Sociodemographic factors such as age, 11,13,14,16,19,20 Caucasian ethnicity, 13,14,18,20 and lower socioeconomic status 13,16,20,21 were significantly associated with PIOU in older adults.…”

“…Studies consistently show that older women are at increased risk of PIOU compared to men 11,13–20 . In general and veteran population studies, physical 15,16,18,20,21 and mental disorder comorbidities 16,17,19,20,22 have been associated with an increased risk of PIOU, except for one study showing a protective effect in those with two or more psychiatric comorbidities 18 .…”