The association of opioid prescribing continuity and the risk of opioid use disorder among older adults.

Abstract

Lower opioid prescribing continuity is associated with a higher risk of opioid-related adverse events. This study aimed to evaluate the association between opioid prescribing continuity and risk of opioid use disorder (OUD). Older adults (≥ 65 years) on long-term opioid therapy (LTOT) were identified from 2012 to 2020 5 % Medicare claims data. The study outcome was OUD. Opioid prescribing continuity, measured using the continuity of care index (COCI), was treated as a time-varying predictor measured monthly from LTOT initiation until outcome/censoring. The association between COCI and risk of OUD was evaluated using an extended Cox regression model. Of 153,570 patients, 7.61 % (n = 11,697) developed OUD after LTOT initiation. The mean (SD) age was 75.74 (8.42) years and 70.16 % (n = 107,743) were female. After adjusting for covariates, patients with medium COCI (adjusted hazard ratio [aHR] = 1.76, 95 % CI 1.58 - 1.96; p < .001) and high COCI (aHR = 1.32, 95 % CI 1.22 - 1.44; p < .001) had higher OUD risk compared to those with low COCI. Patients with high COCI (aHR = 0.75, 95 % CI 0.69 - 0.82; p < .001) had significantly lower hazard of OUD than those with medium COCI. Greater opioid prescribing continuity may promote OUD detection, highlighting the importance of consistent care for better management of opioid-related conditions. Alternatively, highly fragmented care among patients with LTOT may lead to lower detection of OUD, despite patients potentially being at higher risk for OUD. Thus, it is important to build trustful patient-prescriber relationships for early OUD detection and management.