Observational Evidence Linking Psychotropic Medicines to the Dispensing of Opioid Agents in Later Life

Overview

Journal Psychogeriatrics

Specialties Geriatrics
Psychology

Date 2024 Apr 1

PMID 38561326

Authors

Osvaldo P Almeida

Amy Page

Frank M Sanfilippo

David B Preen

Christopher Etherton-Beer

Affiliations

Soon will be listed here.

Abstract

Background: The use of opioid medicines is common in developed countries, particularly among older adults and those with mental health disorders. It is unclear if the association between mental disorders and opioid medicines is causal, or is due to reverse causality or confounding.

Methods: We used a 10% random sample of the Australian Pharmaceutical Benefits Scheme (years 2012-2022) to examine the cross-sectional, case-control and longitudinal association between the dispensing of antidepressants, anxiolytics, hypnotics, antipsychotics and lithium, and opioid medicines. We used logistic regression, structural equation models (SEM), and Cox regression to analyze the data. Analyses were adjusted for age (years), sex, and number of non-psychotropic medicines dispensed during the year.

Results: The 2022 file contained 804 334 individuals aged 50 years or over (53.1% women), of whom 181 690 (22.6%) received an opioid medicine. The adjusted odds ratio of being dispensed opioid medicines was 1.44 (99% CI = 1.42-1.46) for antidepressants, 1.97 (99% CI = 1.92-2.03) for anxiolytics, 1.55 (99% CI = 1.51-1.60) for hypnotics, 1.32 (99% CI = 1.27-1.38) for antipsychotics, and 0.60 (99% CI = 0.53-0.69) for lithium. Similar associations were noticed when we compared participants who were or not dispensed opioid medicines in 2022 for exposure to psychotropic agents between 2012 and 2021. SEM confirmed that this association was not due to reverse causality. The dispensing of antidepressants was associated with increased adjusted hazard (HR) of subsequent dispensing of opioid medicines (HR = 1.29, 99% CI = 1.27-1.30). Similar associations were observed for anxiolytics, hypnotics and antipsychotics, but not lithium.

Conclusions: The dispensing of opioid medicines is higher among older individuals exposed to antidepressants, anxiolytics, hypnotics and antipsychotics than those who are not. These associations are not due to reverse causality or study design. Preventive strategies seeking to minimise the risk of inappropriate use of opioid medicines in later life should consider targeting this high-risk population.

References

Malhi G, Bassett D, Boyce P, Bryant R, Fitzgerald P, Fritz K . Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2015; 49(12):1087-206. DOI: 10.1177/0004867415617657. View

Bedene A, Lijfering W, Niesters M, van Velzen M, Rosendaal F, Bouvy M . Opioid Prescription Patterns and Risk Factors Associated With Opioid Use in the Netherlands. JAMA Netw Open. 2019; 2(8):e1910223. PMC: 6716286. DOI: 10.1001/jamanetworkopen.2019.10223. View

Jobski K, Luque Ramos A, Albrecht K, Hoffmann F . Pain, depressive symptoms and medication in German patients with rheumatoid arthritis-results from the linking patient-reported outcomes with claims data for health services research in rheumatology (PROCLAIR) study. Pharmacoepidemiol Drug Saf. 2017; 26(7):766-774. DOI: 10.1002/pds.4202. View

Chiu Y, Silman A, Macfarlane G, Ray D, Gupta A, Dickens C . Poor sleep and depression are independently associated with a reduced pain threshold. Results of a population based study. Pain. 2005; 115(3):316-321. DOI: 10.1016/j.pain.2005.03.009. View

Gilsa Hansen D, Rosholm J, Gichangi A, Vach W . Increased use of antidepressants at the end of life: population-based study among people aged 65 years and above. Age Ageing. 2007; 36(4):449-54. DOI: 10.1093/ageing/afm056. View

Bergen A, Cil G, Sargent L, Dave C . Frailty Risks of Prescription Analgesics and Sedatives across Frailty Models: the Health and Retirement Study. Drugs Aging. 2022; 39(5):377-387. DOI: 10.1007/s40266-022-00941-2. View

Warner N, Mielke M, Verdoorn B, Knopman D, Hooten W, Habermann E . Pain, Opioid Analgesics, and Cognition: A Conceptual Framework in Older Adults. Pain Med. 2022; 24(2):171-181. PMC: 9890310. DOI: 10.1093/pm/pnac113. View

Lalic S, Ilomaki J, Bell J, Korhonen M, Gisev N . Prevalence and incidence of prescription opioid analgesic use in Australia. Br J Clin Pharmacol. 2018; 85(1):202-215. PMC: 6303244. DOI: 10.1111/bcp.13792. View

Khan S, Heller D, Latty L, LaSure M, Brown T . A Retrospective Study of Psychotropic Drug Use and Prescription Opioid Initiation Among Older Adults. Popul Health Manag. 2021; 25(1):126-133. DOI: 10.1089/pop.2021.0129. View

10.

Spivak S, Cullen B, Eaton W, Nugent K, Spivak A, Fenton A . Prescription opioid use among individuals with serious mental illness. Psychiatry Res. 2018; 267:85-87. DOI: 10.1016/j.psychres.2018.05.075. View

11.

Hudgins J, Porter J, Monuteaux M, Bourgeois F . Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS Med. 2019; 16(11):e1002922. PMC: 6830740. DOI: 10.1371/journal.pmed.1002922. View

12.

Minichino A, Chiaie R, Cruccu G, Piroso S, Stefano G, Francesconi M . Pain-processing abnormalities in bipolar I disorder, bipolar II disorder, and schizophrenia: A novel trait marker for psychosis proneness and functional outcome?. Bipolar Disord. 2016; 18(7):591-601. DOI: 10.1111/bdi.12439. View

13.

Woo A . Depression and Anxiety in Pain. Rev Pain. 2015; 4(1):8-12. PMC: 4590059. DOI: 10.1177/204946371000400103. View

14.

Fayaz A, Croft P, Langford R, Donaldson L, Jones G . Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016; 6(6):e010364. PMC: 4932255. DOI: 10.1136/bmjopen-2015-010364. View

15.

Austin A, Short N . Sexual Violence, Mental Health, and Prescription Opioid Use and Misuse. Am J Prev Med. 2020; 59(6):818-827. DOI: 10.1016/j.amepre.2020.06.019. View

16.

Pergolizzi Jr J, Gharibo C, Passik S, Labhsetwar S, Taylor Jr R, Pergolizzi J . Dynamic risk factors in the misuse of opioid analgesics. J Psychosom Res. 2012; 72(6):443-51. DOI: 10.1016/j.jpsychores.2012.02.009. View

17.

Frenk S, Lukacs S, Gu Q . Factors Associated with Prescription Opioid Analgesic Use in the US Population, 2011-2014. Pain Med. 2018; 20(7):1338-1346. PMC: 6699916. DOI: 10.1093/pm/pny158. View

18.

Richards B, Whittle S, Buchbinder R . Antidepressants for pain management in rheumatoid arthritis. Cochrane Database Syst Rev. 2011; (11):CD008920. DOI: 10.1002/14651858.CD008920.pub2. View

19.

Dart R, Iwanicki J, Black J, Olsen H, Severtson S . Measuring prescription opioid misuse and its consequences. Br J Clin Pharmacol. 2021; 87(4):1647-1653. DOI: 10.1111/bcp.14791. View

20.

Mullachery P, Lima-Costa M, Loyola Filho A . Prevalence of pain and use of prescription opioids among older adults: results from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Lancet Reg Health Am. 2023; 20:100459. PMC: 9996352. DOI: 10.1016/j.lana.2023.100459. View