Long-term Use of Opioid Patches Common in Alzheimer's Patients

Megan Brooks

November 21, 2016

Long-term use of opioids for noncancer pain is common in community-dwelling individuals with Alzheimer's disease (AD), a new Finnish study shows.

"In previous studies, we have found long-term use of antipsychotics and benzodiazepines is more common among people with AD,” first author Aleksi Hamina, MSc (Pharm), of the University of Eastern Finland, Kuopio, told Medscape Medical News. "We wanted to find out whether this was true for opioids as well.

"We also hypothesized that transdermal opioids, which are more commonly used among persons with AD, would lead to long-term use more frequently," he explained. "We found that long-term use of opioid patches was twice as common among those with AD."

The study was published online November 4 in Pain.

Safety Concern

For the study, investigators used the cohort from the Medication Use and Alzheimer's Disease (MEDALZ) study, which includes all community-dwelling individuals diagnosed with AD in Finland during 2005 and 2011 and matched comparison individuals without AD. After excluding those receiving active treatment for cancer, 62,074 individuals with AD and 62,074 individuals without AD were included in the analysis.

Opioids were used by 13,111 individuals with AD and by 16,659 without AD. Overall long-term opioid use (≥180 days) was more common among those without AD than those with AD (8.7% vs 7.2%, P < .0001).

However, among opioid users, the prevalence of long-term opioid use was slightly higher among those with AD compared to those without AD (34.2% vs 32.3%, P = .0004).

In addition, long-term use of transdermal opioids was more than twofold higher among opioid users with AD (13.2%) compared to users without AD (5.5%).

In addition to the presence of AD, factors associated with long-term opioid use included being 80 years of age or older, being female, having rheumatoid arthritis or osteoporosis, having low socioeconomic status, having a history of substance abuse, and having a history of long-term benzodiazepine use.

"Clinical conclusions from register-based data are always a bit tricky, but the rate of long-term opioid use together with benzodiazepines was very high, and this practice is a safety concern," said Hamina.

"We hope that clinicians remember to carefully monitor opioid use and adjust it according to pain and possible side effects among all older people, although it is impossible to say whether this was done or not from our data," he added.

US Perspective

Reached for comment, Heather M. Snyder, PhD, Alzheimer's Association senior director of medical and scientific operations, said, "It's important to note that this study is based on the nationwide register in Finland, and there are differences in both the system as well as medical practice between countries, including between Finland and the US.

"We don't have a hard and fast study" of the use of opioids in the patients with dementia or AD, "but we have reached out to several physicians, and this is not something that they report seeing in noncancer individuals in their clinics," Dr Snyder told Medscape Medical News.

She added that long-term use of opioids in patients with AD could lead to problems, such as increased risk for falls, oversedation, constipation, and possible changes in cognition.

Andrew Kolodny, MD, codirector, opioid policy research, Institute for Behavioral Health, Brandeis University in Waltham, Massachusetts, noted that in general, there is "massive overprescribing of opioids in this country to elderly people.

"Anecdotally," he noted, "I have heard of elderly people put on opioids then winding up diagnosed with dementia, even ending up in a nursing home, when in reality the issue was that they had been overmedicated with opioids and they looked like they had dementia."

Dr Kolodny believes the issue of opioids in the general elderly population needs greater attention.

"The media tends to focus on heroin in younger people, when in fact the opioid crisis is probably more severe in the older population," he told Medscape Medical News. "When you look at data involving overdose deaths, you see a drop among the elderly, but that's not because there are fewer overdoses. It's because an elderly person who dies of an overdose has multiple medical problems and it doesn't get picked up as an overdose death," he noted.

As for Europe, "unfortunately, they are now following in our footsteps," Dr Kolodny said. "There has been a tripling of opioid prescribing over the past decade in Europe, and there is serious concern that as they catch up to us in opioid prescribing, they are going to wind up with the same problem we have."

The study received no commercial funding. Several authors have disclosed relationships with various pharmaceutical companies, which are listed in the original article. Dr Kolodny and Dr Snyder have disclosed no relevant financial relationships.

Pain. Published online November 4, 2016. Abstract

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