Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Abstract

Background/Objectives: Potentially inappropriate opioid prescribing (PIP) may contribute to risk for fatal opioid overdose among older adults (age 50+). Our objective was to examine the effect of age on the likelihood of PIP exposure, as well as the effect of PIP exposure on adverse outcomes. Design: Retrospective cohort study Setting: Data from multiple state agencies in Massachusetts, 2011–2015 Participants: Over 3 million adult Massachusetts residents (3,078,163) who received at least one prescription opioid during the study period; approximately half (1,589,365) were older adults (age 50+). Measurements: We measured exposure to five types of PIP: high-dose opioids, co-prescription with benzodiazepines, multiple opioid prescribers, multiple opioid pharmacies, and continuous opioid therapy without a pain diagnosis. We examined three adverse outcomes: non-fatal opioid overdose, fatal opioid overdose, and all-cause mortality. Results: The rate of any PIP exposure increased with age, ranging from 2% among individuals age 18–29 to 14% among those age 50 and older. Older adults also had elevated rates of exposure to two or more different types of PIP, including 5% of adults age 50–69 and 4% of adults age 70 or older, in comparison to 2.5% of age 40–49 and lower percentages in younger age groups. Among covariates assessed, increasing age was the greatest positive predictor of PIP exposure. In analyses stratified by age, exposure to both any PIP and specific types of PIP were associated with non-fatal overdose, fatal overdose, and all-cause mortality among both younger and older adults. Conclusion: Older adults are more likely to be exposed to PIP, which elevates their risk for adverse events. Strategies to reduce exposure to PIP, and to improve outcomes among those already exposed, will be instrumental to addressing the opioid crisis as it manifests among older adults.

Opioid initiation and injection transition in rural northern New England: A mixed-methods approach

“…The association of prescription opioid use, either medically or nonmedically, with subsequent opioid use has been well-described ( Grau et al, 2007 ; Lankenau et al, 2012 ; Mars et al, 2014 ; Rose et al, 2018 ). Factors associated with prescription opioid initiation, misuse, and overdose include potentially inappropriate opioid prescribing, such as multiple prescribers and co-prescription of opioids and benzodiazepines ( Rose et al, 2019 ; Sun et al, 2017 ). The role of the over-prescription of opioids as a feature of the urban risk environment has also been well-studied ( Ciccarone, 2018 ; Grau et al, 2007 ).…”

“…The role of the over-prescription of opioids as a feature of the urban risk environment has also been well-studied ( Ciccarone, 2018 ; Grau et al, 2007 ). Strong associations exist among inappropriate opioid prescribing, risk for overdose, and all-cause mortality ( Rose et al, 2018 , 2019 ; Stopka et al, 2017 ). Additionally, abrupt discontinuation of opioid prescriptions and inadequate tapering is known to lead to transitions to heroin and fentanyl use and elevated overdose risk ( Brady et al, 2015 ; Mars et al, 2014 ; Somerville et al, 2017 ; Mark and Parish, 2019 ).…”

A qualitative study of big data and the opioid epidemic: recommendations for data governance

“…Described in detail elsewhere [13][14][15], innovative solutions were used to protect data privacy, even beyond the standards set by federal and state law, and to create mechanisms for data sharing. Studies conducted with PHD data over the past five years have been critical to documenting the causes and consequences of the opioid epidemic [7,[17][18][19][20][21][22][23][24].The PHD Warehouse is a groundbreaking essential resource for conducting data-driven public health surveillance, resource allocation, intervention planning, and innovative research [25][26][27].…”

Heterogeneity in Prescription Opioid Pain Reliever Misuse Across Age Groups: 2015–2017 National Survey on Drug Use and Health

“…19 A study using data from the 2009-2014 National Survey on Drug Use and Health (NSDUH) found that a medical source for misused opioids was more common among older adults than younger adults. 14 Given that older adults are more likely to be co-prescribed opioids and benzodiazepines than younger adults 20 and that benzodiazepine use elevates opioid overdose risk, 21 older adults may experience heightened consequences from opioid misuse. While heroin accounts for more hospitalizations and deaths among younger adults, prescription opioids overwhelmingly account for hospitalizations and death among older adults.…”

“…While heroin accounts for more hospitalizations and deaths among younger adults, prescription opioids overwhelmingly account for hospitalizations and death among older adults. 20,22 The objective of this study is to further characterize the extent to which opioid misuse presents differently across age groups, particularly older adults. Using the 2015-2017 NSDUH data on individuals with past-year prescription opioid misuse, we examine how prescription opioid source (i.e., medical, social, and illicit/other) and motives for misuse vary across age groups.…”