Objectives: Previous research shows fragmentation of care among older adults maybe associated with high-risk opioid prescriptions. This project aims to describe the continuity of opioid prescribing and prescriber characteristics among older adults with chronic non-cancer pain (CNCP) who are on long-term opioid therapy (LTOT) and to evaluate the association of continuity of opioid prescribing and prescriber characteristics with the risk of opioid-related adverse events (ORAEs).

Methods: This study employed a nested case-control design using the 5% random sample of the national Medicare administrative claims data for the years 2012-2016. Eligible individuals experiencing a composite outcome of ORAEs were defined as cases and matched to controls using incidence density sampling. Continuity of opioid prescribing, operationalized using the continuity of care index (COCI), and prescriber specialty were assessed among all eligible individuals. Conditional logistic regression was conducted to assess the relationships of interest after accounting for known confounders.

Results: A total of 35,189 older adults starting a new LTOT episode were found to be eligible for inclusion. Less than 1 in 10 (9.2%) individuals received at least one prescription from a pain specialist and 39.0% (13,721) of eligible individuals had a low COCI score. After accounting for known covariates, individuals with low (OR:1.45; 95%CI:1.08–1.94) and medium (OR:1.37; 95%CI: 1.04–1.79) COCI were found to have greater odds of experiencing ORAEs, compared to individuals with high COCI. These results were consistent in sensitivity analyses when Herfindahl index scores were used to measure continuity of opioid prescribing. Receiving a prescription from a pain specialist was not significantly associated with ORAEs (OR: 0.71; 95%CI: 0.46–1.09).

Conclusion: Continuity of opioid prescribing was associated with safety events in the current study and may represent better potential for quality of care than other existing measures in this area.