Long-term use of opioids for nonmalignant pain among community-dwelling persons with and without Alzheimer disease in Finland: a nationwide register-based study

Abstract

Persons with Alzheimer disease (AD) commonly present with chronic nonmalignant pain, but long-term use of opioids among this population has not been studied previously. Our aim was to investigate the prevalence of long-term (≥180 days) use of opioids for nonmalignant pain and associated factors among community-dwelling persons with AD and to compare the prevalence with a matched cohort without AD. The Medication use and Alzheimer's disease (MEDALZ) cohort was used for this study, comprising all community-dwelling persons diagnosed with AD in Finland during 2005 to 2011 and their matched comparison persons without AD. After exclusion of persons with active cancer treatment, 62,074 persons with and 62,074 persons without AD were included in this study. Data were collected from nationwide registers. Opioids were used by 13,111 persons with and by 16,659 without AD. Overall long-term opioid use was more common among persons without AD (8.7%) than among persons with AD (7.2%, P < 0.0001). However, among opioid users, prevalence of long-term opioid use was slightly higher among persons with AD than among those without AD (34.2% vs 32.3%, respectively, P = 0.0004). Long-term use of transdermal opioids was more than 2-fold among opioid users with AD (13.2%) compared with users without AD (5.5%). Factors associated with long-term opioid use included AD, age ≥80 years, female sex, rheumatoid arthritis, osteoporosis, low socioeconomic position, history of substance abuse, and long-term benzodiazepine use. Prevalence of long-term opioid use was somewhat similar among both groups. Among persons with AD, long-term opioid use was strongly associated with transdermal opioids.

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

“…45,46 On the other hand, the lower prevalence of opioid use may indicate the clinical reality of the benefits of reducing sedative ADRs in vulnerable persons with AD. The prevalence and duration of concomitant BZDR and opioid use were higher among persons without AD than among those with AD, although BZDR use was more common in the AD group.…”

“…Earlier studies have revealed that individuals with AD or dementia are less likely to be prescribed analgesic medications than those without AD or dementia. 45,46 On the other hand, the lower prevalence of opioid use may indicate the clinical reality of the benefits of reducing sedative ADRs in vulnerable persons with AD. Specific reasons for this difference will require further study.…”

“…57 Furthermore, a history of long-term BZDR use has been associated with long-term opioid use and chronic opioid use is more common in individuals without AD than among those with AD. 45 The risk of prescription drug misuse and unintentional overdose may be higher among individuals with a history of previous substance abuse or long-term BZDR use. Thus, prescribing these drugs in the presence of previous substance use disorder or chronic BZDR use should be considered with care and co-use should be monitored regularly.…”

“…It has been previously reported that transdermal opioids are more commonly used in individuals with AD than those without AD. 45 In Finland, only buprenorphine and fentanyl are available as transdermal formulations and this partly explains the trend. However, the use of strong opioids should be limited to situations where alternative drugs provide insufficient pain control.…”

Hospital-Treated Pneumonia Associated with Opioid Use Among Community Dwellers with Alzheimer’s Disease

“…Recent studies have shown that pain in dementia is frequently treated with opioids [3,4]. Even long-term use of opioids is common in dementia, yet slightly less so than among older people generally [5,6]. However, older persons are more susceptible to opioid-related adverse drug effects and events (ADEs) [7,8].…”