Risk of chronic opioid use in older persons with pre-existing anxiety

Anna K. Moffat, PhD; Nicole L. Pratt, PhD; Mhairi Kerr, MSc; Lisa M. Kalisch Ellett, PhD; Elizabeth E. Roughead, PhD

doi:10.5055/jom.2020.0551

Authors

Anna K. Moffat, PhD
Nicole L. Pratt, PhD
Mhairi Kerr, MSc
Lisa M. Kalisch Ellett, PhD
Elizabeth E. Roughead, PhD

DOI:

https://doi.org/10.5055/jom.2020.0551

Keywords:

chronic opioid use, anxiety, risk, older

Abstract

Objective: Work that has shown a relationship between anxiety and chronic opioid use has not focused on older people specifically, despite the additional risks in older populations. This study aimed to understand whether anxiety prior to opioid initiation increased the likelihood of chronic opioid use over time in persons aged 60 years or older.

Design: Administrative claims data were used to calculate time between initiation of opioids and a first chronic episode of opioid use. Patients were classified as having a history of anxiety if they were dispensed medicines in the anxiolytics class or had a hospitalization event for anxiety prior to treatment with an opioid. Proportional hazards models were used to compare the likelihood of experiencing a chronic episode of opioid use between those with and without a history of anxiety.

Results: The cohort was 15,000 persons, of which, 5,076 (34 percent) had history of anxiety. Those with anxiety prior to their first opioid dispensing were 30 percent more likely to have an episode of chronic use after adjustment for age, gender, number of comorbidities, and prior surgery (HR = 1.30, 95% CI = 1.16-1.47). The risk of a chronic episode in patients who had surgery prior to initiation of an opioid was 60 percent greater in those with anxiety compared to no anxiety (HR = 1.60, 95% CI = 1.21-2.11) and 24 percent greater in those with anxiety but no prior surgery (HR = 1.24, 95% CI = 1.08-1.42).

Conclusions: A significant proportion of older people will have a chronic episode of opioid use. This risk is increased where a history of anxiety is present.

Author Biographies

Anna K. Moffat, PhD

Evaluation Leader, Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

Nicole L. Pratt, PhD

Associate Professor, Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

Mhairi Kerr, MSc

Statistician, Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

Lisa M. Kalisch Ellett, PhD

Senior Research Fellow, Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

Elizabeth E. Roughead, PhD

Professor, Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

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