Pain, Multimorbidity, Opioid-Drug Interactions and Risk for Opioid Use Disorder or Overdose in Older Adults - This study proposes longitudinal research among older adults to assess the associations of uncontrolled pain, co-occurring chronic conditions or geriatric symptoms (multimorbidity), and opioid–drug interactions with risk for opioid use disorder (OUD) or overdose (OD). This study is responsive to AHRQ’s special interest (NOT-HS- 21-010) in research to address substance use disorders, including OUD and OD in older adults. Older adults have experienced significant increases in OUD or OD in the last decade despite a decrease in the number of opioid prescriptions, signaling an urgent need to identify factors beyond prescription opioid use that contribute to OUD/OD to inform interventions in older populations. Pain, multimorbidity, and polypharmacy, all strongly associated with advancing age, are frequently noted as potential risk factors for OUD/OD in older adults, but relevant evidence is lacking. Relieving pain is the most frequent motive for opioid misuse in older adults, but to what extent uncontrolled pain contributes to risk for OUD/OD is unknown. Multimorbidity is highly prevalent in older adults with OUD or OD, but its association with uncontrolled pain and the joint association of multimorbidity and uncontrolled pain with risk for OUD/OD are unknown. There is also limited understanding regarding the risk of OUD/OD when prescription opioids for pain treatment are concurrently used with drugs for other chronic comorbid conditions that may interact with opioids in older adults. To fill these research gaps, this proposed study will leverage a 100% Medicare sample and Medicare data linked to nationally representative longitudinal survey data to study the associations of pain, multimorbidity, and opioid-drug interactions with risk for OUD/OD outcomes of older adults with chronic pain. Specifically, we will examine the associations between pain control and risk for OUD or OD in older adults diagnosed with chronic pain and treated with prescription opioids. We will also evaluate the association of multimorbidity with pain control and their joint association with OUD/OD risk in older patients. Furthermore, we will assess the extent to which concurrent use of opioids with drugs for treating common comorbid conditions with chronic pain in older adults is associated with OUD/OD outcomes in older adults with chronic pain. We will measure both pain and high-impact pain and quantify multimorbidity through both a diagnosis-based index and the presence of geriatric symptoms that are underdiagnosed or not diagnosable. Our study will provide empirical evidence on the extent to which uncontrolled pain, multimorbidity, and opioid-drug interactions may play a role in increasing risk for OUD or OD among older adults with chronic pain. Given the accelerated growth of the US aging population and the continuing increase in OUD, OD, and opioid misuse, our data will inform interventions that integrate care for chronic pain and other chronic comorbid conditions to improve pain control while reducing OUD or OD in older adults.
