Dosing Profiles of Opioid and Benzodiazepine Use Associated with Risk of Injurious Falls Among US Medicare Beneficiaries: Group-based Multi-trajectory Models

Saturday, August 27, 2022

8:30 AM – 8:45 AM CEST

Location: C1M0

Publication Number: 134

Background: Opioid (OP) and/or benzodiazepine (BZ) use in older adults causes central nervous system depression and can increase risk of falls/fractures compared to individual use. While clinical guidelines do not recommend concurrent use, OP-BZ use might be warranted for patients with pain and other conditions (e.g., anxiety); thus, there is need to understand the differential risk of falls/fractures among distinct OP, BZ and OP-BZ use trajectories

Objectives: To investigate the dose/duration patterns of OP, BZ, and OP-BZ use most associated with injurious falls (including fractures)

Methods: This retrospective cohort study included fee-for-service, non-cancer Medicare beneficiaries initiating OP and/or BZ in 2016-2018. We excluded patients with falls/fractures or accidental injuries within 6 months before drug initiation. Based on average daily morphine milligram equivalents (MME) for OPs and diazepam milligram equivalents (DME) for BZs, we used group-based multi-trajectory models to identify distinct OP/BZ/OP-BZ dose/duration patterns in the 3 months after drug initiation. Using a validated algorithm, we estimated the risk of time to first injurious fall within 6 months after drug initiation using inverse-probability-of-treatment-weighted Cox proportional hazards models

Results: Among 622,588 beneficiaries (age≥65=84%, female=58%, White=83%, having an injurious fall=0.83%), we identified 13 distinct trajectories (5 OP-only, 4 BZ-only, and 4 OP-BZ). The 6-month injurious fall risk varied by trajectory when compared to individuals in the lowest-dose OP-only trajectory (44.9% of the cohort). An increased risk was observed in 3 OP-only trajectories (14%) with the following dose/duration phenotypes: medium-dose/declining, medium-dose/sustained, and high-dose/declining (adjusted hazard ratios[aHR] range=1.54-2.22). For BZ-only users, 2 trajectories had high injurious fall risks (5.2%): medium-dose/sustained and high-dose/sustained (aHR range= 1.31-1.81). There were 2 OP-BZ trajectories with high injurious fall risks (1.2%): low-dose/sustained OP + medium-dose/sustained BZ (aHR=2.64, 95%CI=2.08-3.36) and medium-dose/declining OP + high-dose/sustained BZ (aHR=1.72, 95%CI=1.26-2.35)

Conclusions: Among Medicare fee-for-service beneficiaries, injurious fall risks varied substantially across OP, BZ, and OP-BZ trajectories. While much focus has been on issues with concurrent OP-BZ use, we identified high risk of injurious falls among OP-only and BZ-only trajectories. Our results highlight the need for careful consideration of not only dose or duration of use alone, but also the combination of dose and duration in the benefit/risk assessment of concurrent OP-BZ treatment

Presenting Author(s)

Juan M. Hincapie-Castillo, PharmD, MS, PhD

Assistant Professor
University of North Carolina at Chapel Hill
Durham, North Carolina, United States

Slides

Co-Author(s)

WG

Walid Gellad, MD, MPH

Associate Professor
Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, United States
BJ

Bobby Jones

Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, United States
JL

Jeannie Lee

Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, United States
JH

James Huang

Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida
Gainesville, FL, United States
CC

Ching-Yuan Chang

Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, United States
DW

Debbie Wilson, PhD, RN

Affiliate Clinical Assistant Professor
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida
Gainesville, FL, United States
GR

Gary Reisfield

Divisions of Addiction Medicine & Forensic Psychiatry, Departments of Psychiatry & Anesthesiology, College of Medicine, University of Florida, United States
CK

Chian Kwoh

University of Arizona Arthritis Center, College of Medicine, University of Arizona, United States
KN

Khoa Nguyen

Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, United States
CD

Chris Delcher, PhD

Director, Institute for Pharmaceutical Outcomes and Policy
Pharmacy Practice & Science, Institute for Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Kentucky, KY, United States
CH

Christopher Harle

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States
YG

Yong Ge

Department of Management Information Systems, University of Arizona, United States
RS

Ronald Shorr, M.D., M.S.

Director, Geriatric Research Education and Clinical Center
North Florida/South Georgia Veterans Health System Geriatric Research Education and Clinical Center
Gainesville, FL, United States
ZM

Zachary Marcum

School of Pharmacy, University of Washington, United States
Seonkyeong Yang

University of Florida College of Pharmacy
PH

Pei-Lin Huang, MHS

Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, United States
LA

Lauren Adkins, MLIS, AHIP

Assistant University Librarian
Health Science Center Libraries, University of Florida
Gainesville, FL, United States
Weihsuan Jenny Lo-Ciganic, PhD

Associate Professor
University of Florida Department of Pharmaceutical Outcomes and Policy
Gainesville, Florida, United States