{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:54:23Z","timestamp":1761562463659,"version":"build-2065373602"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T00:00:00Z","timestamp":1550793600000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Study Objectives<\/jats:title><jats:p>To assess chronic potentially unsafe medication use among older adults using opioids chronically versus those who did not, to assess the likelihood of chronically using medications to treat adverse effects associated with chronic opioid use, and to characterize the differences in chronic potentially unsafe medication use at three morphine equivalent dose (<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content>) levels\/day (less than 50<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content>, 50\u201090<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content>, and more than 90<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cross\u2010sectional analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Source<\/jats:title><jats:p>Prescription claims data from a national telehealth Medication Therapy Management (<jats:styled-content style=\"fixed-case\">MTM<\/jats:styled-content>) provider for the year 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>All Medicare Part D beneficiaries (65\u00a0years and older [older adults]) from one Medicare Part D plan provider in one state who were eligible to receive <jats:styled-content style=\"fixed-case\">MTM<\/jats:styled-content> services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>Medication claims were limited to refills in a 120\u2010day window from one Medicare Part D provider. Chronic medication use was defined as having a total days' medication supply of 84\u00a0days or more. Odds ratios (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>s) and \u03c7<jats:sup>2<\/jats:sup> tests were used to compare chronic medication use among beneficiaries who were chronic opioid users versus nonopioid users. Analyses were repeated among chronic opioid users at the less than 50<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content>, 50\u201390<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content>, and more than 90<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content> levels. Unpaired <jats:italic>t<\/jats:italic> tests and Welch's analysis of variance paired with Games\u2010Howell post hoc tests were used for continuous variables. Older adult (mean age 76\u00a0years) chronic opioid users were more likely to use muscle relaxants chronically (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.67, 95% confidence interval [CI] 2.20\u20133.25), benzodiazepines (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.08, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.87\u20132.31), hypnotics (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.98, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.67\u20132.34), antidepressants (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.64, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.51\u20131.77), and nonsteroidal antiinflammatory drugs (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.78, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.59\u20131.98) versus nonopioid users. Further, chronic opioid users were 3.04 times (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.05\u20134.51) more likely to use muscle relaxants and benzodiazepines concomitantly chronically and also more likely to use medications chronically to treat gastrointestinal reflux disease, constipation, estrogen loss, nausea and vomiting, and edema. Very high\u2010dose (more than 90<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content>\/day) chronic opioid users were more likely than low\u2010dose users (less than 50MED) to use antidepressants (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.51, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.15\u20131.97, p=0.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Older adults with chronic opioid use were more likely to use potentially unsafe medications chronically. These data demonstrated discordance between national prescribing guidelines and real\u2010world practice among older adults with chronic pain in one Medicare Part D plan.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2218","type":"journal-article","created":{"date-parts":[[2019,1,13]],"date-time":"2019-01-13T06:48:32Z","timestamp":1547362112000},"page":"140-149","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Potentially Unsafe Chronic Medication Use Among Older Adult Chronic Opioid Users"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9601-9413","authenticated-orcid":false,"given":"Armando","family":"Silva Almodovar","sequence":"first","affiliation":[{"name":"Institute of Therapeutic Innovations and Outcomes (ITIO) The Ohio State University College of Pharmacy Columbus Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milap C.","family":"Nahata","sequence":"additional","affiliation":[{"name":"Institute of Therapeutic Innovations and Outcomes (ITIO) The Ohio State University College of Pharmacy Columbus Ohio"},{"name":"The Ohio State University College of Medicine Columbus Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,2,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2013.07.029"},{"key":"e_1_2_8_3_1","first-page":"1","article-title":"Prescription opioid analgesic use among adults: United States, 1999\u20102012","volume":"189","author":"Frenk SM","year":"2015","journal-title":"NCHS Data Brief"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1507771"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6501e1"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2016.06.006"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13702"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afu145"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1909"},{"key":"e_1_2_8_10_1","unstructured":"Benzodiazepine Often Used in Older People Despite Risks [Internet].Bethesda MD:National Institutes of Health;2015[updated January 12 2015]. 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