(105) Patient and Health System Factors Associated with Potentially Inappropriate Opioid Use in Non-Cancer Community-Dwelling Older Adults

Publication Number: 779

Background: Opioid use and related harms are rising in older adults. Given the prevalence of polypharmacy and multimorbidity, older adults are at increased risk for potentially inappropriate medication use. Yet, few studies have explicitly focused on potentially inappropriate opioid use.

Objectives: To study the factors associated with opioid use and potentially inappropriate opioid use in older adults.

Methods: Secondary analyses were conducted using health surveys and administrative data from Quebec, Canada. Older adults aged 65 and above were recruited between 2011 and 2013 in primary care clinics to participate in face-to-face interviews. The sample included 945 older adults without a malignant cancer diagnosis over the study period or any cancer diagnosis in the two years surrounding opioid use. Opioid use was identified using data from the public drug plan. Potentially inappropriate opioid use was defined using the Beers 2019 list. Multinomial regression analyses were conducted to study the factors associated with opioid use and potentially inappropriate opioid use during a 3-year follow-up. Factors were selected based on the conceptual framework developed by the American Agency for Healthcare Research and Quality.

Results: In this cohort, 26.2% used an opioid and 18.4% were categorized as potentially inappropriate opioid users, according to the Beers criteria. Factors associated with potentially inappropriate opioid use compared to opioid use included patient factors such as sex (OR=2.75, CI: 1.39-5.41), psychological distress score measured using the Kessler K10 scale (OR=1.06, CI: 1.01-1.12), and the number of emergency department visits in the 3 years before opioid use (OR=1.50, CI: 1.10-2.06), and healthcare system factors, such as consulting in a private clinic with 3 physicians or more (OR=2.40, CI: 1.20-4.81). Factors associated with opioid use compared to no use included the number of emergency department visits (OR=0.71, CI: 0.52-0.96) and consulting in a private clinic with 3 physicians or more (OR=0.52, CI: 0.29-0.94).

Conclusions: This study highlights key factors associated with potentially inappropriate opioid use and opioid use, both at the individual and healthcare system levels. These findings can be used to develop targeted interventions aimed at reducing potentially inappropriate opioid use in older adults at risk.