Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Anita Iacono¹, Michael A Campitelli², Susan E Bronskill^{2

3

4}, David B Hogan⁵, Andrea Iaboni^{6

7}, Laura C Maclagan², Tara Gomes^{2

3

8

9}, Mina Tadrous^{2

4

9}, Charity Evans¹⁰, Andrea Gruneir^{2

11}, Qi Guan^{2

3}, Thomas Hadjistavropoulos¹², Cecilia Cotton¹³, Sudeep S Gill^{2

14}, Dallas P Seitz^{2

15}, Joanne Ho^{16

17}, Colleen J Maxwell^{18

19

20}

Affiliations

¹ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
² ICES, Toronto, ON, Canada.
³ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
⁵ Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁶ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
⁷ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁸ Unity Health, Toronto, ON, Canada.
⁹ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
¹⁰ College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
¹¹ Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
¹² Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada.
¹³ Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.
¹⁴ Department of Medicine, Queen's University, Kingston, ON, Canada.
¹⁵ Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹⁷ Schlegel Research Institute for Aging, Waterloo, ON, Canada.
¹⁸ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. colleen.maxwell@uwaterloo.ca.
¹⁹ ICES, Toronto, ON, Canada. colleen.maxwell@uwaterloo.ca.
²⁰ School of Pharmacy, University of Waterloo, Waterloo, ON, Canada. colleen.maxwell@uwaterloo.ca.

PMID: 35976489
PMCID: PMC9381389
DOI: 10.1007/s40266-022-00972-9

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Anita Iacono et al. Drugs Aging. 2022 Oct.

. 2022 Oct;39(10):811-827.

doi: 10.1007/s40266-022-00972-9. Epub 2022 Aug 17.

Authors

Affiliations

¹ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
² ICES, Toronto, ON, Canada.
³ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
⁵ Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁶ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
⁷ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁸ Unity Health, Toronto, ON, Canada.
⁹ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
¹⁰ College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
¹¹ Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
¹² Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada.
¹³ Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.
¹⁴ Department of Medicine, Queen's University, Kingston, ON, Canada.
¹⁵ Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹⁷ Schlegel Research Institute for Aging, Waterloo, ON, Canada.
¹⁸ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. colleen.maxwell@uwaterloo.ca.
¹⁹ ICES, Toronto, ON, Canada. colleen.maxwell@uwaterloo.ca.
²⁰ School of Pharmacy, University of Waterloo, Waterloo, ON, Canada. colleen.maxwell@uwaterloo.ca.

PMID: 35976489
PMCID: PMC9381389
DOI: 10.1007/s40266-022-00972-9

Abstract

Background: Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management.

Objectives: The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity.

Methods: We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018-2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents' health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents' characteristics and opioid use, overall and across strata capturing pain frequency and intensity.

Results: Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57-0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66-0.72) or dementia (aRR = 0.76, 95% CI 0.74-0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32-1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74-1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28-1.38), or antidepressants (aRR = 1.31, 95% CI 1.27-1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata.

Conclusions: Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting.

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Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

**Fig. 1**
Adjusted risk ratio for opioid use associated with sociodemographic and clinical characteristics, stratified by pain frequency and intensity, among Ontario long-term care (LTC) residents

**Fig. 2**
Adjusted risk ratio for opioid use associated with pain-related conditions, stratified by pain frequency and intensity, among Ontario long-term care residents

**Fig. 3**
Adjusted risk ratio for opioid use associated with select drug classes, stratified by pain frequency and intensity, among Ontario long-term care residents. *Incl* including

**Fig. 4**
a Adjusted prevalence of opioid use by cognitive impairment level and pain frequency and intensity, among Ontario long-term care residents. b Adjusted prevalence of opioid use by cognitive impairment level and number of pain-related conditions, among Ontario long-term care residents assessed as having no pain

See this image and copyright information in PMC

References

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Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

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Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Authors

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Conflict of interest statement

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