Predictors of Multiwave Opioid Use Among Older American Adults

Background and Objectives Despite limited analgesic benefits, long-term opioid therapy (L-TOT) is common among older adults with chronic pain. Extended opioid use poses a threat to older adults as aging metabolisms retain opioids for longer, increasing the risk of injury, overdose, and other negative health outcomes. In contrast to predictors of general opioid use, predictors of L-TOT in older adults are not well documented. We aimed to identify such predictors using all available data on self-reported opioid use in the Health and Retirement Study.Research Design and Methods Using 5 waves of data, respondents (N = 10,713) aged 51 and older were identified as reporting no opioid use (n = 8,621), a single wave of use (n = 1,410), or multiple waves of use (n = 682). We conducted a multinomial logistic regression to predict both single- and multiwave opioid use relative to no use. Demographic, socioeconomic, geographic, health, and health care-related factors were included in our model.Results Multivariable findings show that, relative to nonusers, both single- and multiwave users were significantly more likely to be younger (relative risk ratio [RRR] = 1.33; RRR = 2.88); report lower household wealth (RRR = 1.47; RRR = 2.88); live in the U.S. Midwest (RRR = 1.29; RRR = 1.56), South (RRR = 1.34; RRR = 1.58), or West (RRR = 1.46; RRR = 2.34); experience interfering pain (RRR = 1.59; RRR = 3.39), back pain (RRR = 1.35; RRR = 1.53), or arthritic pain (RRR = 1.46; RRR = 2.32); and see the doctor frequently (RRR = 1.50; RRR = 2.02). Multiwave users were less likely to be Black (RRR = 0.69) or Hispanic (RRR = 0.45), and less likely to be never married (RRR = 0.52).Discussion and Implications We identified demographic, socioeconomic, geographic, and health care-related predictors of chronic multiyear opioid use. Our focus on individuals taking opioids for this extended duration is novel. Differences in opioid use by geographic region and frequency of doctor visits particularly warrant attention from policy-makers and researchers. We make additional recommendations based on a sensitivity analysis limited to 2016-2020 data.

Automated summary

Background: Long-term opioid therapy (L-TOT) is common among older adults with chronic pain, but there is limited understanding of the predictors for such therapy in this population. This study aimed to identify predictors of L-TOT using data from the Health and Retirement Study. Methods: A multinomial logistic regression was conducted using 5 waves of data from the study, with participants aged 51 and older categorized into nonusers, single-wave users, and multiwave users of opioids. Various demographic, socioeconomic, geographic, health, and healthcare-related factors were included in the model. Results: The results showed that both single-wave users and multiwave users were more likely to be younger, have lower household wealth, live in certain regions of the U.S., and have certain types of pain. Additionally, multiwave users were less likely to be Black or Hispanic, and less likely to be never married. Discussion and Implications: This study identified several predictors of long-term opioid use among older adults, including demographic, socioeconomic, geographic, and healthcare-related factors. The findings highlight the need for policy-makers and researchers to pay attention to regional differences in opioid use and the frequency of doctor visits. Recommendations based on a sensitivity analysis of more recent data were also provided.