title: 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.
authors.affiliation: aKuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland bFaculty of Health Sciences, School of Pharmacy, University of Eastern Finland, Kuopio, Finland cFaculty of Health Sciences, Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland dNational Institute for Health and Welfare, Helsinki, Finland eDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden fDepartment of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland gCancer Society of Finland, Helsinki, Finland hDepartment of Oncology, University of Turku, Turku, Finland iDepartment of Psychiatry, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Aleksi
authors.initials: A
authors.lastname: Hamina
authors.forename: Heidi
authors.initials: H
authors.lastname: Taipale
authors.forename: Antti
authors.initials: A
authors.lastname: Tanskanen
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Tolppanen
authors.forename: Niina
authors.initials: N
authors.lastname: Karttunen
authors.forename: Liisa
authors.initials: L
authors.lastname: Pylkkänen
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D057187:Independent Living; D008297:Male; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid