OBJECTIVES: To determine the incidence and predictors of persistent opioid use in opioid-naïve older adults (≥65 years) without a cancer diagnosis.

METHODS: This was a retrospective cohort study using national healthcare administrative databases. Individuals were included if they had a hospital or emergency department visit and initiated a new opioid episode from January 2013 to June 2018. The first date of the opioid prescription during the study period was defined as the index date. All eligible individuals were followed up for 6 months after the index date. Those who died during the follow-up period or had any cancer diagnosis one year before or 6 months after the index date were excluded. The primary outcome of interest was incident persistent opioid use defined as having continuously filled ≥1 opioid prescription in the 91 to 180 days after the index date. Multivariable logistic regression was used to identify predictors of persistent opioid use.

RESULTS: The final cohort included 268,857 opioid-naïve non-cancer patients. Of these, 5,849 (2.2%) became persistent opioid users. Several predictors of persistent opioid use were identified. Of these, the use of fentanyl (adjusted odds ratio(AOR)=3.61; 95%CI 2.63–4.95), slow-release opioid preparations (AOR=3.02; 95%CI 2.78–3.29), strong opioids (AOR=2.03; 95%CI 1.55–2.65), Charlson Comorbidity Score ≥3 (AOR=2.09; 95% CI 1.78–2.46), history of substance abuse (AOR=1.52; 95%CI 1.35–1.72), living in most socioeconomically deprived areas (AOR=1.40; 95%CI 1.27-1.54), and anti-epileptics (AOR=2.07; 95%CI 1.89–2.26), non-opioid analgesics (AOR=2.05; 95%CI 1.89–2.21), antipsychotics (AOR=1.96; 95%CI 1.78–2.17), or antidepressants (AOR=1.50; 95%CI 1.41–1.59) medication use were the strongest predictors of persistent opioid use.

CONCLUSIONS: This is one of the very few studies that examined predictors of persistent opioid use among general older adults. The findings will enable healthcare providers and policymakers to target early interventions to prevent future opioid-related adverse events.