Incident opioid drug use among older adults with chronic obstructive pulmonary disease: a population-based cohort study.
OBJECTIVE
The purpose of the present study was to describe the scope, pattern and patient characteristics associated with incident opioid use among older adults with chronic obstructive pulmonary disease (COPD).


METHODS
This was a retrospective population-based cohort study using Ontario, Canada, healthcare administrative data. Study participants were individuals aged 66 years and older with physician-diagnosed COPD, identified using a validated algorithm, who were not receiving palliative care. We examined the incidence of oral opioid receipt between 1 April 2003 and 31 March 2012, as well as several patterns of incident opioid drug use.


RESULTS
Among 107,109 community-dwelling and 16,207 long-term care resident older adults with COPD, 72,962 (68.1%) and 8811 (54.4%), respectively, received an incident opioid drug during the observation period. Among long-term care residents, multiple opioid dispensings (8.8%), dispensings for >30 days' duration (up to 19.8%), second dispensings (35-43%) and early refills (24.2%) were observed. Incident opioid dispensing was also observed to occur during COPD exacerbations (6.9% among all long-term care residents; 18.1% among long-term care residents with frequent exacerbations). These same patterns of incident opioid use occurred among community-dwelling individuals, but with relatively lower frequencies.


CONCLUSIONS
New opioid use was high among older adults with COPD. Potential safety concerns are raised by the degree and pattern of new opioid use, but further studies are needed to evaluate if adverse events are associated with opioid drug use in this older and respiratory-vulnerable population.
Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.|Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Nicholas T
NT
Vozoris
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Xuesong
X
Wang
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Hadas D
HD
Fischer
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Andrea S
AS
Gershon
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Division of General Internal Medicine, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
Chaim M
CM
Bell
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Sudeep S
SS
Gill
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Denis E
DE
O'Donnell
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Peter C
PC
Austin
Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.|Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Anne L
AL
Stephenson
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Paula A
PA
Rochon
D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012189:Retrospective Studies
D000701:Analgesics, Opioid
COPD; elderly; narcotics; opioids; pharmacoepidemiology