Characteristics of Older Adults Receiving Opioids in Primary Care: Treatment Duration and Outcomes

• Published in: Pain medicine (Malden, Mass.) Mass.), 2010-07, Vol.11 (7), p.1063-1071
• Main Authors: Reid, M. Carrington, Henderson Jr, Charles R., Papaleontiou, Maria, Amanfo, Leslie, Olkhovskaya, Yelena, Moore, Alison A., Parikh, Sagar S., Turner, Barbara J.
• Format: Article
• Language: English
• Subjects: Abuse/Misuse; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - therapeutic use; Chronic Disease - drug therapy; Chronic Non-Cancer Pain; Cohort Studies; Efficacy; Elderly; Female; Humans; Male; New York City; Opioid Analgesics; Pain - drug therapy; Primary Health Care; Retrospective Studies; Safety; Treatment Outcome
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/j.1526-4637.2010.00883.x

Objective.  To describe characteristics of older adults who received opioids for chronic non‐cancer pain (CP), ascertain types of opioid treatments received, and examine associations between patient characteristics and treatment outcomes. Design.  Retrospective cohort study. Setting.  Primary care practice in New York City. Patients.  Eligible patients were ≥65 and newly started on an opioid for CP. Outcome Measures.  Patient characteristics and provider treatments, as well as duration of opioid therapy, proportion discontinuing therapy, and evidence of pain reduction and continued use of opioid for more than 1 year. Other outcomes included the presence and type(s) of side effects, abuse/misuse behaviors, and adverse events. Results.  Participants (N = 133) had a mean age of 82 (range = 65–105), were mostly female (84%), and white (74%). Common indications for opioid treatment included back pain (37%) and osteoarthritis (35%). Mean duration of opioid use was 388 days (range = 0–1,880). Short‐acting analgesics were most commonly prescribed. Physicians recorded side effects in 40% of cases. Opioids were discontinued in 48% of cases, mostly due to side effects/lack of efficacy. Pain reduction was documented in 66% of patient records, while 32% reported less pain and continued treatment for ≥1 year. Three percent displayed abuse/misuse behaviors, and 5% were hospitalized due to opioid‐related adverse events. Conclusions.  Over 50% of older patients with CP tolerated treatment. Treatment was discontinued in 48% of cases, mostly due to side effects and lack of analgesic efficacy. Efforts are needed to establish the long‐term safety and efficacy of opioid treatment for CP in diverse older patient populations.