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Opioid prescribing and risk of drug-opioid interactions in older discharged patients with polypharmacy in Australia

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Abstract

Background Opioids are commonly prescribed to managing chronic pain in older persons. However, these patients are often at risk of drug-opioid interactions due to polypharmacy. Objectives To identify the prevalence of opioid prescribing and drug-opioid interactions in poly-medicated older patients and factors associated with opioid prescribing. Setting Patients were included if they were admitted to the Royal Adelaide Hospital between September 2015 and August 2016, aged ≥ 75 years and took ≥ 5 medications at discharge. Methods After ethics approval, data of were retrospectively collected from case notes. The Charlson Comorbidity Index and Drug Burden Index were determined and opioids were classified as strong or weak. The association between opioid use and concurrent medications was computed using logistic regression and the results presented as odds ratios (OR) and 95% confidence intervals (95% CI), adjusted for age, sex, Charlson Comorbidity Index, number of prescribed medications and modified-Drug Burden Index. Main outcome measure Association between concurrent medications and opioid prescribing. Results 15,000 geriatric admissions were identified, of which 1192 were included. A total of 283 (23.7%) patients were prescribed opioids, with oxycodone accounting for 56% of these prescriptions. Opioid users were prescribed more medications (11.2 vs. 9.0, P < 0.001) and had higher Drug Burden Index (1.2 vs. 0.14, P < 0.001) compared to non-users. Opioid use was associated with concurrent prescription of antiepileptics (OR = 1.7, 95% CI 1.1–2.6), and negatively associated with Charlson Comorbidity Index (OR = 0.9, 95% CI 0.8–0.98) and concurrent use of antipsychotics (OR = 0.5, 95% CI 0.3–0.9) and beta blocking agents (OR = 0.4, 95% CI 0.3–0.6). Conclusions Strong opioids were prescribed more often than weak opioids and opioid users presented with characteristics and concurrent medications which increased the risk of opioid related adverse drug effects.

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Acknowledgements

The authors would like to thank the medical records officers at the Royal Adelaide Hospital for their endless support and help while reviewing and collecting patients data.

Funding

No source of funding were used to conduct this study or prepare the manuscript.

Conflicts of interest

The authors have no potentially conflicts of interest that might be relevant to the contents of this manuscript.

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Authors and Affiliations

  1. UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia

    Aymen Ali Al-Qurain, Lemlem G. Gebremichael, Mohammed S. Khan, Desmond B. Williams, Lorraine Mackenzie, Michael S. Roberts & Michael D. Wiese

  2. Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia

    Aymen Ali Al-Qurain, Lemlem G. Gebremichael, Mohammed S. Khan, Lorraine Mackenzie & Michael S. Roberts

  3. Saudi Arabian Cultural Mission, Ministry of Education, Riyadh, Saudi Arabia

    Aymen Ali Al-Qurain

  4. Health and Biomedical Innovation Group, University of South Australia, Adelaide, Australia

    Aymen Ali Al-Qurain & Michael D. Wiese

  5. School of Nursing and Midwifery, University of South Australia, Adelaide, Australia

    Craig Phillips

  6. Royal Adelaide Hospital, Adelaide, Australia

    Patrick Russell

  7. Therapeutics Research Centre, Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia

    Mohammed S. Khan & Michael S. Roberts

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  1. Aymen Ali Al-Qurain
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Al-Qurain, A.A., Gebremichael, L.G., Khan, M.S. et al. Opioid prescribing and risk of drug-opioid interactions in older discharged patients with polypharmacy in Australia. Int J Clin Pharm 43, 365–374 (2021). https://doi.org/10.1007/s11096-020-01191-1

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