Document Detail

Frequency of long-acting opioid analgesic initiation in opioid-naïve nursing home residents.
MedLine Citation:
PMID:  19375273     Owner:  NLM     Status:  MEDLINE    
A U.S. Food and Drug Administration (FDA) warning against morbidity and death associated with the initiation of transdermal fentanyl in previously opioid-naïve patients has been issued. Additional warnings against opioid-naïve initiation are included in the package inserts for several other long-acting opioids (LAOs). Frail, older nursing home (NH) residents with renal and hepatic insufficiency have increased risk of adverse reactions from initiation of LAOs. Little is known about the frequency of opioid-naïve LAO initiation among NH residents. To ascertain the frequency of LAO initiation among residents residing in Rhode Island NHs, an analysis of 2004-2005 Rhode Island Medicaid pharmacy claims data linked to the Minimum Data Set was conducted. Of the 591 Medicaid residents who initiated therapy with an LAO, 232 (39.3%) were opioid naïve. Furthermore, naïve initiation was more frequent among those with advanced age and those with cognitive impairment. In an exploratory multivariable logistic regression model, opioid-naïve LAO initiation was associated with a diagnosis of Alzheimer's dementia and chewing difficulties. Opioid-naïve residents were also more likely to initiate on fentanyl relative to other LAOs (60.3% vs. 46.4%) and to use higher initial dosages. Given the significance of the FDA warning, including a "black box" warning with transdermal fentanyl, this rate of naïve LAO initiation warrants efforts to further study the prescribing of opioids in NH residents.
David M Dosa; David D Dore; Vincent Mor; Joan M Teno
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.     Date:  2009-04-16
Journal Detail:
Title:  Journal of pain and symptom management     Volume:  38     ISSN:  1873-6513     ISO Abbreviation:  J Pain Symptom Manage     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-13     Completed Date:  2010-01-04     Revised Date:  2013-04-30    
Medline Journal Info:
Nlm Unique ID:  8605836     Medline TA:  J Pain Symptom Manage     Country:  United States    
Other Details:
Languages:  eng     Pagination:  515-21     Citation Subset:  IM    
Center for Gerontology and Health Care Research, The Warren Alpert Medical School at Brown University, Providence, Rhode Island 02903, USA.
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MeSH Terms
Aged, 80 and over
Analgesics, Opioid / therapeutic use*
Drug Utilization Review*
Middle Aged
Nursing Homes / statistics & numerical data*
Pain / epidemiology*,  prevention & control*
Physician's Practice Patterns / statistics & numerical data*
Prescriptions / statistics & numerical data*
Rhode Island / epidemiology
Grant Support
5T32HS000011-21/HS/AHRQ HHS; T32 HS000011/HS/AHRQ HHS
Reg. No./Substance:
0/Analgesics, Opioid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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