Background Limited evidence exists on the short- and long-term safety of discontinuing versus continuing chronic opioid therapy (COT) among patients with Alzheimer’s disease and related dementias (ADRD). Methods This cohort study was conducted among 162,677 older residents with ADRD and receipt of COT using a 100% Medicare nursing home sample. Discontinuation of COT was defined as no opioid refills for ≥90 days. Primary outcomes were rates of pain-related hospitalisation, pain-related emergency department visit, injury, opioid use disorder (OUD) and opioid overdose (OD) measured by diagnosis codes at quarterly intervals during 1- and 2-year follow-ups. Poisson regression models were fit using generalised estimating equations with inverse probability of treatment weights to model quarterly outcome rates between residents who discontinued versus continued COT. Results The study sample consisted of 218,040 resident episodes with COT; of these episodes, 180,916 residents (83%) continued COT, whereas 37,124 residents (17%) subsequently discontinued COT. Discontinuing (vs. continuing) COT was associated with higher rates of all outcomes in the first quarter, but these associations attenuated over time. The adjusted rates of injury, OUD and OD were 0, 69 and 60% lower at the 1-year follow-up and 11, 81 and 79% lower at the 2-year follow-up, respectively, for residents who discontinued versus continued COT, with no difference in the adjusted rates of pain-related hospitalisations or emergency department visits. Conclusions The rates of adverse outcomes were higher in the first quarter but lower or non-differential at 1-year and 2-year follow-ups between COT discontinuers versus continuers among older residents with ADRD.

中文翻译：

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患有阿尔茨海默病和相关痴呆症的老年人停止长期阿片类药物治疗的短期和长期安全性

背景 关于阿尔茨海默病及相关痴呆 (ADRD) 患者停止与继续慢性阿片类药物治疗 (COT) 的短期和长期安全性的证据有限。方法 这项队列研究是在 162,677 名患有 ADRD 并接受 COT 的老年居民中进行的，使用 100% 医疗保险疗养院样本。终止 COT 的定义是 ≥90 天没有补充阿片类药物。主要结局是在 1 年和 2 年的随访期间，每季度通过诊断代码测量与疼痛相关的住院率、与疼痛相关的急诊就诊率、损伤率、阿片类药物使用障碍 (OUD) 和阿片类药物过量 (OD) 的发生率。使用具有治疗权重逆概率的广义估计方程拟合泊松回归模型，以对停止使用 COT 与继续使用 COT 的居民之间的季度结果率进行建模。结果 研究样本包括 218,040 例患有 COT 的居民；在这些事件中，180,916 名居民 (83%) 继续使用 COT，而 37,124 名居民 (17%) 随后停止了 COT。停止（与继续）COT 与第一季度所有结果的较高发生率相关，但这些关联随着时间的推移而减弱。与继续治疗的居民相比，停止治疗的居民在 1 年随访中的调整后损伤率、OUD 和 OD 分别降低了 0%、69% 和 60%，在 2 年随访中分别降低了 11%、81% 和 79% COT，调整后的疼痛相关住院或急诊就诊率没有差异。结论 在患有 ADRD 的老年居民中，第一季度不良结果发生率较高，但在 1 年和 2 年随访中，COT 停药者与继续者之间的不良结果发生率较低或无差异。