High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference

Background It was reported that the risk of opioid overdose death increased with increasing opioid dose and little is known whether sex difference influences the risk of opioid dose escalation or overdose. Objective This study examined the relationship between sex difference and opioid dose escal...

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Main Authors:	Zin, Che Suraya, Taufek, Nor Hidayah, Alias, Nor Elina, Meor Ahmad, Mazlila
Format:	Conference or Workshop Item
Language:	English English
Published:	2019
Subjects:	RM147 Administration of Drugs and Other Therapeutic Agents
Online Access:	http://irep.iium.edu.my/71731/ http://irep.iium.edu.my/71731/ http://irep.iium.edu.my/71731/1/190420_aseaps_irep_docx.pdf http://irep.iium.edu.my/71731/2/190320-Poster_aseap_csz.pdf

id	iium-71731
recordtype	eprints
spelling	iium-717312019-04-22T07:56:37Z http://irep.iium.edu.my/71731/ High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference Zin, Che Suraya Taufek, Nor Hidayah Alias, Nor Elina Meor Ahmad, Mazlila RM147 Administration of Drugs and Other Therapeutic Agents Background It was reported that the risk of opioid overdose death increased with increasing opioid dose and little is known whether sex difference influences the risk of opioid dose escalation or overdose. Objective This study examined the relationship between sex difference and opioid dose escalation in patients with long term opioid therapy. Setting and participants This retrospective cohort study was conducted at tertiary hospital settings in Malaysia using electronic prescription records. Patients with long term opioid therapy of ≥90 days of opioid prescriptions and aged ≥18 years old with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine and tramadol) between 1st January 2011, and 31st December 2016 were included. Follow-up was started from patients’ first opioid prescription until discontinuation of therapy, death from any cause or the end of the study period, with no interval of 120 days between the successive prescriptions. The risk of high opioid dose escalation to ≥100 mg/day and ≥200 mg/day relative to men and women was measured using a Cox proportional hazard model which was controlled for the effect of age. The adjusted hazard ratios and 95% Confidence Intervals (CIs) were used to summarize the risk of dose escalation using Stata v15.1 Results A total of 4688 patients with long term opioid therapy were identified. Of these, 248 (5.29%) escalated to high opioid doses of ≥100mg/day and 69 (1.47%) escalated to ≥200mg/day. The median time at risk to reach ≥100 and ≥200 mg/day was 126 days for men and 162 days for women. After adjusted for age, men were more likely than women to be escalated to high-dose opioid therapy of ≥100 mg/day (adjusted hazard ratio 2.32; 95% CI 1.79 to 3.00, p<0.0001) and ≥200 mg/day (adjusted hazard ratio 6.10; 95% CI 3.39 to 10.98, p<0.0001). Conclusions The risk of opioid dose escalation was different between men and women in which men are at higher risk than women for escalation to high-dose opioid therapy. Further research is necessary to understand the factors contributing to the observed differences and its association with clinical outcomes. 2019 Conference or Workshop Item NonPeerReviewed application/pdf en http://irep.iium.edu.my/71731/1/190420_aseaps_irep_docx.pdf application/pdf en http://irep.iium.edu.my/71731/2/190320-Poster_aseap_csz.pdf Zin, Che Suraya and Taufek, Nor Hidayah and Alias, Nor Elina and Meor Ahmad, Mazlila (2019) High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference. In: 8th Congress of the Association of South-East Asian Pain Societies (ASEAPS) 2019, 11th-14th April 2019, Kuching, Sarawak Malaysia. http://www.aseaps2019.com/eposter_view.php?catID=OT&fileName=ABST031_OT_OT03.pdf
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English
topic	RM147 Administration of Drugs and Other Therapeutic Agents
spellingShingle	RM147 Administration of Drugs and Other Therapeutic Agents Zin, Che Suraya Taufek, Nor Hidayah Alias, Nor Elina Meor Ahmad, Mazlila High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference
description	Background It was reported that the risk of opioid overdose death increased with increasing opioid dose and little is known whether sex difference influences the risk of opioid dose escalation or overdose. Objective This study examined the relationship between sex difference and opioid dose escalation in patients with long term opioid therapy. Setting and participants This retrospective cohort study was conducted at tertiary hospital settings in Malaysia using electronic prescription records. Patients with long term opioid therapy of ≥90 days of opioid prescriptions and aged ≥18 years old with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine and tramadol) between 1st January 2011, and 31st December 2016 were included. Follow-up was started from patients’ first opioid prescription until discontinuation of therapy, death from any cause or the end of the study period, with no interval of 120 days between the successive prescriptions. The risk of high opioid dose escalation to ≥100 mg/day and ≥200 mg/day relative to men and women was measured using a Cox proportional hazard model which was controlled for the effect of age. The adjusted hazard ratios and 95% Confidence Intervals (CIs) were used to summarize the risk of dose escalation using Stata v15.1 Results A total of 4688 patients with long term opioid therapy were identified. Of these, 248 (5.29%) escalated to high opioid doses of ≥100mg/day and 69 (1.47%) escalated to ≥200mg/day. The median time at risk to reach ≥100 and ≥200 mg/day was 126 days for men and 162 days for women. After adjusted for age, men were more likely than women to be escalated to high-dose opioid therapy of ≥100 mg/day (adjusted hazard ratio 2.32; 95% CI 1.79 to 3.00, p<0.0001) and ≥200 mg/day (adjusted hazard ratio 6.10; 95% CI 3.39 to 10.98, p<0.0001). Conclusions The risk of opioid dose escalation was different between men and women in which men are at higher risk than women for escalation to high-dose opioid therapy. Further research is necessary to understand the factors contributing to the observed differences and its association with clinical outcomes.
format	Conference or Workshop Item
author	Zin, Che Suraya Taufek, Nor Hidayah Alias, Nor Elina Meor Ahmad, Mazlila
author_facet	Zin, Che Suraya Taufek, Nor Hidayah Alias, Nor Elina Meor Ahmad, Mazlila
author_sort	Zin, Che Suraya
title	High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference
title_short	High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference
title_full	High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference
title_fullStr	High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference
title_full_unstemmed	High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference
title_sort	high opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: sex difference
publishDate	2019
url	http://irep.iium.edu.my/71731/ http://irep.iium.edu.my/71731/ http://irep.iium.edu.my/71731/1/190420_aseaps_irep_docx.pdf http://irep.iium.edu.my/71731/2/190320-Poster_aseap_csz.pdf
first_indexed	2023-09-18T21:41:43Z
last_indexed	2023-09-18T21:41:43Z
_version_	1777413184498434048

High opioid dose escalation to 100 and 200 mg per day in patients with long term opioid therapy: Sex difference

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