Andrea Iaboni1, Michael A Campitelli1, Susan E Bronskill1, Christina Diong1, Matthew Kumar1, Laura C Maclagan1, Tara Gomes1, Mina Tadrous1, Colleen J Maxwell2. 1. Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont. 2. Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont. colleen.maxwell@uwaterloo.ca.
Abstract
BACKGROUND: Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. METHODS: We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. RESULTS: Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). INTERPRETATION: Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes. Copyright 2019, Joule Inc. or its licensors.
BACKGROUND: Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. METHODS: We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. RESULTS: Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). INTERPRETATION: Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes. Copyright 2019, Joule Inc. or its licensors.
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Authors: Anita Iacono; Michael A Campitelli; Susan E Bronskill; David B Hogan; Andrea Iaboni; Laura C Maclagan; Tara Gomes; Mina Tadrous; Charity Evans; Andrea Gruneir; Qi Guan; Thomas Hadjistavropoulos; Cecilia Cotton; Sudeep S Gill; Dallas P Seitz; Joanne Ho; Colleen J Maxwell Journal: Drugs Aging Date: 2022-08-17 Impact factor: 4.271
Authors: Michael A Campitelli; Susan E Bronskill; Laura C Maclagan; Daniel A Harris; Cecilia A Cotton; Mina Tadrous; Andrea Gruneir; David B Hogan; Colleen J Maxwell Journal: JAMA Netw Open Date: 2021-08-02