Chronic prescription opioid use in MS: Associations with adverse outcomes and acute medical service utilization
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Background
The purpose of this study is to examine whether chronic prescription opioid use in individuals with MS is associated with adverse medical outcomes and acute medical service utilization.
Methods
This propensity score-matched, retrospective, cohort study included data from 15,377 Veterans with MS obtained from national VA administrative data. Veterans with filled prescriptions for chronic opioid therapy ( n =1,908) in 2017 were matched 1:1 and compared to those not prescribed chronic opioid therapy using logistic regression models adjusted for propensity score, age, sex, race, and ethnicity. Outcomes included falls, fractures, wounds, and all-cause mortality, as well as acute inpatient and emergency department utilization, and intensive care unit admission in 2018.
Results
The chronic opioid group had a higher likelihood of a fall (OR adj =1.77, 95% CI, 1.03– 3.02, p =0.038), inpatient admission (OR adj =1.21, 95% CI, 1.02–1.43, p =0.028), and emergency department visit (OR adj =1.25, 95% CI, 1.09–1.43, p =0.001). Significant differences were not detected between those prescribed and not prescribed chronic opioid therapy on fractures, wounds, all-cause mortality, and intensive care unit admission, although in all cases the occurrence of these outcomes was higher in the opioid group.
Conclusion
Chronic prescription opioid use among Veterans with MS was associated with a higher likelihood of adverse outcome (falls) and higher intensity health care utilization (inpatient admissions and emergency department visits) in the following year. Education regarding MS-specific risks of opioid use should be provided at initial prescription and re-evaluation of risks versus benefits should be conducted regularly.
