Mohammad Insaf, Garwood Candice L, Binns-Emerick Lisa
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA; Department of Pharmacy, Corewell Health Dearborn Hospital, Dearborn, MI, USA.
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA; Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, MI, USA; Rosa Parks Geriatric Clinic, Detroit Medical Center, Detroit, MI, USA.
Ann Palliat Med. 2024 Jul;13(4):901-913. doi: 10.21037/apm-23-488. Epub 2024 May 9.
The prevalence of chronic non-cancer pain (CNCP) in older adults is high. Opioids carry significant risk for harm in older adults. Yet, many older adults are established on long-term opioid therapy for the treatment of CNCP despite limited documented efficacy. Many of the non-opioid options to treat pain present challenges in this population. Since challenges with tapering patients off of opioids exist, older adults may remain established on long-term opioid therapy for CNCP. While opioid use is less scrutinized for older adults receiving palliative care, significant safety concerns exist. Therefore, efforts to mitigate risks for older adults receiving long-term opioids for CNCP and for palliative care are essential. Pharmacists as members of the interprofessional team are equipped to improve safety among older adults on chronic opioid therapy. Among patients receiving palliative care, collaboration with palliative care specialists is also key. The purpose of this narrative review is to describe risk mitigation strategies for opioid use among older adults with CNCP and those receiving palliative care.
Data were identified by searching PubMed (January 1, 1990 to February 21, 2024) using the following search terms: older adults, opioids, chronic pain, palliative care, and pharmacist. The search was repeated using terms geriatric, elderly, opiates, narcotics, and controlled substances. Non-English articles and observational studies with fewer than 100 patients were excluded. Major North American and European guidelines were reviewed. Additional literature was obtained through review of relevant references of identified articles.
A variety of risk mitigation strategies to improve safety for older adults using opioids exist. They include risk assessment, tapering opioids, reducing high-risk concomitant medications, utilizing non-opioid therapies, screening for and treatment of opioid use disorder (OUD), toxicology testing, co-prescribing naloxone, utilizing controlled substance agreements, reviewing prescription drug monitoring program data, prescriber and patient education, and collaboration with pharmacists and palliative care specialists.
There are many opioid risk mitigation strategies for older adults. Collaboration with pharmacists and palliative care specialists can be an effective means for implementing strategies to optimize opioid safety for older adults with CNCP and those receiving palliative care.
老年人慢性非癌性疼痛（CNCP）的患病率很高。阿片类药物对老年人有显著危害风险。然而，尽管疗效记录有限，许多老年人仍长期接受阿片类药物治疗CNCP。许多用于治疗疼痛的非阿片类药物选择在该人群中存在挑战。由于在使患者逐渐减少阿片类药物使用方面存在挑战，老年人可能仍长期接受CNCP的阿片类药物治疗。虽然对于接受姑息治疗的老年人，阿片类药物的使用审查较少，但存在重大安全问题。因此，努力降低接受长期阿片类药物治疗CNCP和姑息治疗的老年人的风险至关重要。药剂师作为跨专业团队的成员，有能力提高接受慢性阿片类药物治疗的老年人的安全性。在接受姑息治疗的患者中，与姑息治疗专家合作也很关键。本叙述性综述的目的是描述针对患有CNCP的老年人和接受姑息治疗的老年人使用阿片类药物的风险缓解策略。
通过在PubMed（1990年1月1日至2024年2月21日）中搜索以下检索词来识别数据：老年人、阿片类药物、慢性疼痛、姑息治疗、药剂师。使用老年、年长、阿片、麻醉品和管制物质等检索词重复搜索。排除非英文文章和患者少于100例的观察性研究。审查了北美和欧洲的主要指南。通过审查已识别文章的相关参考文献获得了更多文献。
存在多种提高老年人使用阿片类药物安全性的风险缓解策略。它们包括风险评估、逐渐减少阿片类药物用量、减少高风险的合并用药、采用非阿片类药物疗法、筛查和治疗阿片类药物使用障碍（OUD）、毒理学检测（药物检测）、联合开具纳洛酮、利用管制物质协议、审查处方药监测计划数据、对开处方者和患者进行教育，以及与药剂师和姑息治疗专家合作。
针对老年人有许多阿片类药物风险缓解策略。与药剂师和姑息治疗专家合作可能是为患有CNCP的老年人和接受姑息治疗的老年人实施优化阿片类药物安全性策略的有效手段。
