Earlier this year, the Agency for Healthcare Research and Quality (AHRQ) released a report on trends in hospitalizations of adults related to use of prescription opioid painkillers between 1993 to 2012 [JAMA. 2014;312(16):1621-1623]. The AHRQ report indicated that the largest jump in the rate of hospitalizations related to opioid use was among people ≥85 years of age, followed by adults 65 to 84 years of age and adults 45 to 64 years of age.
In addition, among payers, Medicare assumes the largest average annual increase in the number of opioid-related hospitalizations among its beneficiaries. In 2012, Medicare covered approximately 30% of opioid-related hospitalizations, which is more that double what Medicare covered in 1993.
In 1993, the number of inpatient hospital stays related to opioid overdose among adults 18 to 24 years of age was 70.7 compared with 221.8 in 2012. In 1993, the number of inpatient hospital stays related to opioid overdose among adults 25 to 44 years of age was 188.6 compared with 312.3 in 2012. In 1993, the number of inpatient hospital stays related to opioid overdose among adults 45 to 64 years of age was 66.6 compared with 338.1 in 2012. In 1993, the number of inpatient hospital stays related to opioid overdose among adults 65 to 84 years of age was 46 compared with 230.8 in 2012. In 1993, the number of inpatient hospital stays related to opioid overdose among adults ≥85 years of age was 51.1 compared with 265.3 in 2012. All rates of stays were based on 100,000 population.
“This is an important public health issue, and [older adults] are a major part of the population that is impacted,” said Wilson Compton, MD, deputy director, National Institute on Drug Abuse.
Though the rates of overdose drop off after a person reaches 65 years of age, older adults are more likely to experience adverse effects from opioids. “At the same equivalent dose, an older person is much more likely to experience falls, liver impairment, cardiac toxicity, and cognitive impairment,” said Dr. Compton.
The AHRQ report defines overuse by a range of 16 diagnostic codes that cover opioid abuse, dependence, poisoning, and adverse effects.
The AHRQ authors noted that the average number of secondary diagnoses per hospital discharge almost tripled during the time period analyzed. Therefore, the increase in hospitalizations can be due in part to an increase in diagnoses rather than an increase in cases.
The authors presented the possibility that opioid misuse in the older population could be a factor. Potential other treatment options, such as acetaminophen, nonsteroidal anti-inflammatory drugs, or physical therapy, may be more optimal choices to explore before prescribing an opioid to an older patient. The authors conceded that they did not have enough data to truly determine if this is a factor.
Another factor may be the 2009 updated American Geriatrics Society guidelines on pain management. The organization suggested that in most cases, “All patients with moderate to severe pain, pain-related functional impairment, or diminished quality of life due to pain [should] be considered for opioid therapy.” This recommendation varied significantly from the organizations’ 2002 guidelines on pain.
In addition, little is known about the safety of various opioid painkillers for treatment in older adults.
The report noted that a surge of adults will be reaching older age as the baby boomer generation moves into the ≥65 years of age range; therefore, overuse of opioids is expected to increase.
A study found that by 2020 the nonmedical use of psychotherapeutic drugs is expected to reach 2.4% among adults ≥50 years of age, which is nearly 2.7 million individuals [Ann Epidemiol. 2006;16(4):257-265].—Kerri Fitzgerald