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标题：Age and Gender Trends in Long-Term Opioid Analgesic Use for Noncancer Pain
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作者：Cynthia I. Campbell ; Constance Weisner ; Linda LeResche 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：12
页码：2541-2547
DOI：10.2105/AJPH.2009.180646
语种：English
出版社：American Public Health Association
摘要：Objectives. We describe age and gender trends in long-term use of prescribed opioids for chronic noncancer pain in 2 large health plans. Methods. Age- and gender-standardized incident (beginning in each year) and prevalent (ongoing) opioid use episodes were estimated with automated health care data from 1997 to 2005. Profiles of opioid use in 2005 by age and gender were also compared. Results. From 1997 to 2005, age–gender groups exhibited a total percentage increase ranging from 16% to 87% for incident long-term opioid use and from 61% to 135% for prevalent long-term opioid use. Women had higher opioid use than did men. Older women had the highest prevalence of long-term opioid use (8%–9% in 2005). Concurrent use of sedative-hypnotic drugs and opioids was common, particularly among women. Conclusions. Risks and benefits of long-term opioid use are poorly understood, particularly among older adults. Increased surveillance of the safety of long-term opioid use is needed in community practice settings. Long-term use of opioid analgesics for chronic noncancer pain has increased considerably in recent years,^{1 – 5} but little is known about trends in long-term use of prescribed opioids among specific age and gender groups. The American Geriatric Society recently recommended that opioids be preferred over nonsteroidal anti-inflammatory drugs (NSAIDs) for management of moderate-to-severe chronic pain among older adults,⁶ so it is timely to examine recent trends in opioid use among this population. Potential adverse effects of opioid use include overdose, falls and fractures, respiratory insufficiency, hyperalgesia, interactions with other medications or substances, risk of addiction, and diversion for nonmedical use. These risks differ by age and gender. For example, risks for abuse of prescribed opioid medications may be greatest among young men,⁷ whereas risks for fractures due to falls associated with opioid use may be greatest among older women.⁸ To minimize such risks, an important initial step is to understand the prevalence and long-term trends in opioid use in the general population by age and gender. Women are more likely than are men to report a wide range of chronic pain conditions,⁹ including most musculoskeletal and arthritic pain conditions, common forms of headache, temporomandibular disorders, carpal tunnel syndrome, irritable bowel syndrome, and fibromyalgia.¹⁰ Women report greater severity of pain, longer-lasting and more frequent pain, and more anatomically diffuse pain than do men, and women are more likely to experience multiple pain problems.^{10 , 11} It is therefore not surprising that women use prescribed opioids at higher rates than do men.^{12 , 13} However, prior research has not determined the extent of long-term prescription opioid use among women relative to men. Pain prevalence may change across the life course; some pain conditions increase with age (e.g., joint pain) and some decrease (e.g., abdominal pain and headache).^{11 , 14} Older persons have more chronic pain^{15 , 16} and thus may be more likely to be prescribed opioids for long periods.^{12 , 17} Findings on age differences in prescription opioid use have been contradictory^{12 , 18 , 19} Because older adults generally use more prescribed medications than do younger adults, older adults’ potential for medication interactions with opioid analgesics is greater.^{17 , 20} Older adults have higher prevalence of insomnia,²¹ so concomitant use of pain medications and sedative hypnotics may be common. Other concerns include cognitive impairment, respiratory depression, and ataxia (lack of muscle coordination), which increases risks of falls.²⁰ Undertreatment of pain in older persons may be a consequence,^{17 , 22} although some guidelines recommend opioid analgesics for chronic pain among older adults in preference to NSAIDs.⁶ We describe trends over a 9-year period (1997–2005) in long-term use of prescribed opioid analgesics by age and gender in 2 large integrated health plans that together serve more than 1% of the US population. On the basis of prior research, we expected large increases in long-term opioid use over the study period, with higher prevalence for women than men and higher prevalence for older persons than younger adults.¹² We also provide new information on age–gender differences in patterns of long-term opioid use, including type of medication, dosage levels, and concomitant use of sedative-hypnotic medications.