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We compared mortality rates among new users of either gabapentin or duloxetine with or without concurrent opioids in the 20% Medicare sample. We conducted a new\u2010user design retrospective cohort study, in Medicare enrollees ages 65\u201389\u2009years with noncancer chronic pain and no severe illness who filled prescriptions between 2015 and 2018 for gabapentin (<jats:italic>n<\/jats:italic>\u2009=\u2009233,060) or duloxetine (<jats:italic>n<\/jats:italic>\u2009=\u200934,009). Daily opioid doses, estimated in morphine milligram equivalents (MMEs), were classified into none, low (0\u2009&lt;\u2009MME\u2009&lt;\u200950), and high (\u2265\u200950\u2009MME), based on Centers for Disease Control and Prevention (CDC) recommendations. The outcomes were all\u2010cause mortality (primary) and out\u2010of\u2010hospital mortality (secondary). We used inverse probability of treatment weighting to adjust for differences between gabapentin and duloxetine users. During 116,707 person\u2010years of follow\u2010up, 1,379 patients died. All\u2010cause mortality rate in gabapentin users was 12.16 per 1,000 person\u2010years vs. 9.94 per 1,000 in duloxetine users. Risks were similar for users with no concurrent opioids (adjusted hazard ratio (aHR)\u2009=\u20091.03, 95% confidence interval (CI): 0.80\u20131.31) or low\u2010dose daily opioids (aHR\u2009=\u20091.06, 95% CI: 0.63\u20131.76). However, gabapentin users receiving concurrent high\u2010dose daily opioids had an increased rate of all\u2010cause mortality compared with duloxetine users on high\u2010dose opioids (aHR\u2009=\u20092.03, 95% CI: 1.19\u20133.46). Out\u2010of\u2010hospital mortality yielded similar results. In this retrospective cohort study of Medicare beneficiaries, concurrent use of high\u2010dose opioids and gabapentin was associated with a higher all\u2010cause mortality risk than that for concurrent use of high\u2010dose opioids and duloxetine.<\/jats:p>","DOI":"10.1002\/cpt.3019","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T14:54:21Z","timestamp":1691420061000},"page":"1050-1057","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Concurrent Gabapentin and Opioid Use and Risk of Mortality in Medicare Recipients with Non\u2010Cancer Pain"],"prefix":"10.1111","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2181-7100","authenticated-orcid":false,"given":"Meghan A.","family":"Corriere","sequence":"first","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Vertex Pharmaceuticals  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3143-5915","authenticated-orcid":false,"given":"Laura L.","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Department of Medicine University of Miami  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3404-3802","authenticated-orcid":false,"given":"Alyson L.","family":"Dickson","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8550-5101","authenticated-orcid":false,"given":"Puran","family":"Nepal","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Department of Medicine University of Miami  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathi","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Dale","family":"Plummer","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8166-599X","authenticated-orcid":false,"given":"William D.","family":"Dupont","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1342-4457","authenticated-orcid":false,"given":"Katherine T.","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Michael","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne A.","family":"Ray","sequence":"additional","affiliation":[{"name":"Department of Health Policy Vanderbilt University  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5908-9423","authenticated-orcid":false,"given":"Cecilia P.","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Department of Medicine University of Miami  Miami Florida USA"},{"name":"Bruce W. 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