Clinical Cases Podcast Series-FREE NO CME-2020 Opioid + Sedative Use in COPD Study

2020 Opioid + Sedative Use in COPD Study
Pdf Summary
This retrospective cohort study used a 5% nationally representative Medicare claims sample (2009–2013) to evaluate whether concomitant opioid and sedative use increases respiratory risks among adults aged ≥65 with chronic obstructive pulmonary disease (COPD), compared with opioid use alone. Opioids and sedatives (including benzodiazepines and non-benzodiazepine hypnotics) are frequently prescribed in COPD for dyspnoea, pain, insomnia, anxiety, and depression, but both drug classes can depress respiration and are considered potentially inappropriate in older adults.<br /><br />The cohort included beneficiaries with COPD who newly initiated opioids (after 12 months with no opioids/sedatives) and had continuous Parts A/B/D enrollment. Concomitant exposure was defined by overlapping days of opioid and sedative supply and categorized by total overlap (1–10, 11–30, 31–60, or ≥60 days). “Current” use meant drug supply within 7 days of the censoring date (respiratory event, death, or 12 months); “past” use meant discontinuation ≥7 days earlier. The main outcome was hospitalization or emergency department visits for respiratory events (COPD exacerbations or respiratory depression), with death treated as a competing (terminal) event. Propensity score matching (1:5) and semi-competing risk models were used to reduce confounding and account for death.<br /><br />Among 48,120 eligible beneficiaries, 2,296 (4.8%) had concomitant use; after matching, 1,810 concomitant users were compared with 9,050 opioid-only users. Current short- and medium-term concomitant use significantly increased respiratory event risk versus opioid-only use (HR 2.8 for 1–10 days; HR 9.3 for 11–30 days; HR 5.7 for 31–60 days). Current concomitant use also increased mortality risk, with particularly high death hazards in the 11–60 day overlap groups. In contrast, ≥60 days of current concomitant use and long-term past concomitant use were not associated with increased respiratory events; long-term past use showed lower risks, possibly reflecting tolerance or a “healthy user” effect. Sensitivity analyses (including non-benzodiazepine sedatives and severe COPD subgroups) were generally consistent.<br /><br />The authors conclude that concomitant opioid–sedative prescribing in older COPD patients should be avoided or closely monitored, especially during the initial weeks to months of overlap.
Keywords
COPD
opioids
sedatives
benzodiazepines
respiratory risk
older adults
Medicare claims
concomitant use
hospitalization
mortality