Long-term use of prescription opioids for non-cancer pain and mortality: a population-based, propensity-weighted cohort study

I Hurtado; C Robles; A García-Sempere; F Llopis-Cardona; F Sánchez-Sáez; C Rodríguez-Bernal; S Peiró; G Sanfélix-Gimeno

doi:10.1016/j.puhe.2024.04.009

Long-term use of prescription opioids for non-cancer pain and mortality: a population-based, propensity-weighted cohort study

Public Health. 2024 May 7:232:4-13. doi: 10.1016/j.puhe.2024.04.009. Online ahead of print.

Authors

I Hurtado¹, C Robles¹, A García-Sempere², F Llopis-Cardona¹, F Sánchez-Sáez¹, C Rodríguez-Bernal¹, S Peiró¹, G Sanfélix-Gimeno¹

Affiliations

¹ Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
² Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain. Electronic address: anibal.garcia@fisabio.es.

PMID: 38718737
DOI: 10.1016/j.puhe.2024.04.009

Abstract

Objective: The objective of this study was to identify factors associated with long-term opioid use and to assess the association between long-term use and death.

Study design: Retrospective cohort study combining several population-wide databases and covering a population of five million inhabitants, including all adults who were initiated on opioid treatment from 2014 to 2018 for non-cancer pain.

Methods: We used logistic regression models to identify factors associated with chronic opioid use and carried out survival analyses using multivariable Cox regression modelling for all-cause mortality during follow-up using inverse probability of treatment weighting (IPTW) and propensity scores based on the probability of using opioids chronically.

Results: Among 760,006 patients, 82,423 (10.85%) used opioids for 90 days or more after initiation. Initial therapy characteristics associated with higher risk for long-term use were initiating with long- and short-acting opioids (when compared to tramadol, odds ratio [OR]: 2.63, 95% confidence interval [CI]: 2.57, 2.69 and OR: 1.60, 95%CI: 1.46, 1.76, respectively), using higher daily doses (when compared to 50 morphine milligramme equivalent [MME] or less, prescribing 50 to 89 daily MME, OR: 1.76, 95%CI: 1.65, 1.87; 90 to 119 daily MME, OR: 2.44, 95%CI: 1.99, 3.01; and more than 120 daily MME, OR: 1.77, 95%CI: 1.64, 1.91), and overlapping with gabapentinoids (OR: 2.26, 95%CI: 2.20, 2.32), benzodiazepines (OR: 1.32, 95%CI: 1.30, 1.35), and antipsychotics (OR: 1.21, 95%CI: 1.16, 1.26). After IPTW, chronic opioid use was associated with higher risk of all-cause mortality when compared to short-term use (Hazard Ratio (HR): 1.37, 95%CI: 1.32, 1.42). Sensitivity analyses provided similar results.

Conclusion: These findings may help healthcare managers to identify and address patients at higher risk of long-term use and riskier prescription patterns.

Keywords: Analgesics; Cohort studies; Mortality; Opioid; Risk factors.