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dc.contributor.authorWinn, Aaron N.
dc.contributor.authorCheck, Devon K.
dc.contributor.authorFarkas, Amy
dc.contributor.authorFergestrom, Nicole M.
dc.contributor.authorNeuner, Joan M.
dc.contributor.authorRoberts, Andrew W.
dc.date.accessioned2022-03-22T15:38:15Z
dc.date.available2022-03-22T15:38:15Z
dc.date.issued2020-09-15
dc.identifier.citationWinn AN, Check DK, Farkas A, Fergestrom NM, Neuner JM, Roberts AW. Association of Current Opioid Use With Serious Adverse Events Among Older Adult Survivors of Breast Cancer. JAMA Netw Open. 2020;3(9):e2016858. doi:10.1001/jamanetworkopen.2020.16858en_US
dc.identifier.urihttp://hdl.handle.net/1808/32659
dc.descriptionA grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.en_US
dc.description.abstractImportance: National efforts to improve safe opioid prescribing focus on preventing misuse, overdose, and opioid use disorder. This approach overlooks opportunities to better prevent other serious opioid-related harms in complex populations, such as older adult survivors of cancer. Little is known about the rates and risk factors for comprehensive opioid-related harms in this population.

Objective: To determine rates of multiple opioid-related adverse drug events among older adults who survived breast cancer and estimate the risk of these events associated with opioid use in the year after completing cancer treatment.

Design, Setting, and Participants: This retrospective cohort study used 2007 to 2016 Surveillance, Epidemiology and End Results-Medicare data from fee-for-service Medicare beneficiaries with first cancer diagnosis of stage 0 to III breast cancer at age 66 to 90 years from January 1, 2008, through December 31, 2015, who completed active breast cancer treatment. Data were analyzed from October 31, 2019, to June 10, 2020.

Exposures: Repeated daily measure indicating possession of any prescription opioid supply in Medicare Part D prescription claims.

Main Outcomes and Measures: Adjusted risk ratios (aRRs), estimated using modified Poisson generalized estimating equation models, for adverse drug events related to substance misuse (ie, diagnosed opioid abuse, dependence, or poisoning), other adverse drug events associated with opioid use (ie, gastrointestinal events, infections, falls and fractures, or cardiovascular events), and all-cause hospitalization associated with opioid supply the prior day, controlling for patient characteristics.

Results: Among 38 310 women included in the study (mean [SD] age, 74.3 [6.3] years), there were 0.010 (95% CI, 0.008-0.011) adverse drug events related to substance misuse per 1000 person-days, 0.237 (95% CI, 0.229-0.245) other adverse drug events associated with opioid use per 1000 person-days, and 0.675 (95% CI, 0.662-0.689) all-cause hospitalizations per 1000 person-days. Opioid use was associated with increased risk of adverse drug events related to substance misuse (aRR, 14.62; 95% CI, 9.69-22.05; P < .001), other adverse drug events related to opioid use (aRR, 2.50; 95% CI, 2.11-2.96; P < .001), and all-cause hospitalization (aRR, 2.77; 95% CI, 2.55-3.02; P < .001). In a dose-response effect, individuals with high daily opioid doses had consistently higher risks of all study outcomes compared with individuals who had low opioid doses. Compared with days with no opioid exposure, the risk of any adverse drug event related to substance misuse was 3.4-fold higher for individuals with a current opioid supply ≥50 mg morphine equivalent dose per day (aRR, 3.40; 95% CI, 2.47-4.68; P < .001), while the risk was 2.3-fold higher for individuals with 1 to 49 mg morphine equivalent dose per day (aRR, 2.29; 95% CI, 1.89-2.77; P < .001).

Conclusions and Relevance: These findings suggest that among older adults who survived breast cancer, continued prescription opioid use in the year after completing active cancer treatment was associated with an immediate increased risk of a broad range of serious adverse drug events related to substance misuse and other adverse drug events associated with opioid use. Clinicians should consider the comprehensive risks of managing cancer pain with long-term opioid therapy.
en_US
dc.publisherAmerican Medical Associationen_US
dc.rightsThis is an open access article distributed under the terms of the CC-BY License. © 2020 Winn AN et al. JAMA Network Open.en_US
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.titleAssociation of Current Opioid Use With Serious Adverse Events Among Older Adult Survivors of Breast Canceren_US
dc.typeArticleen_US
dc.identifier.doi10.1001/jamanetworkopen.2020.16858en_US
kusw.oaversionScholarly/refereed, publisher versionen_US
kusw.oapolicyThis item meets KU Open Access policy criteria.en_US
dc.rights.accessrightsopenAccessen_US


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This is an open access article distributed under the terms of the CC-BY License. © 2020 Winn AN et al. JAMA Network Open.
Except where otherwise noted, this item's license is described as: This is an open access article distributed under the terms of the CC-BY License. © 2020 Winn AN et al. JAMA Network Open.