March 29, 2018
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Opioid initiation cuts antipsychotic use in persons with Alzheimer’s disease

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Initiation of prescription opioid analgesics slightly reduced the use of both antipsychotic medications and benzodiazepines in community-dwelling adults with Alzheimer’s disease living in Finland, according to findings published in International Psychogeriatrics.

“Treating pain among persons with dementia is difficult due to problems in communication and subsequently in the diagnosis and evaluation of pain. Pain appears to bring about or worsen the behavioral and psychological symptoms of dementia (eg, agitation, restlessness, depression),” Aleksi Hamina, MSc (Pharm), Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, told Healio Psychiatry.

“Previous research has found that proper pain management has decreased at least some of these symptoms, but ours is the first to find a decrease in symptomatic pharmacotherapy (ie, antipsychotic and benzodiazepines and related drug use),” Hamina continued. “These drugs increase the risk of a number of severe adverse events among persons with dementia, yet they are often used for far longer than recommended.”

Researchers used data from the register-based Medication use and Alzheimer’s disease (MEDALZ) cohort to determine whether initiating opioid use affected the prevalence of antipsychotic and benzodiazepine and related drug use among community-dwelling Finnish adults diagnosed with Alzheimer’s disease between 2010 and 2011. Using interrupted time series, they also compared the prevalence of antipsychotic and benzodiazepine and related drug use among 3,327 adults with Alzheimer’s disease who initiated opioid use and a matched cohort of 3,325 adults who did not in 30-day periods within 6 months before and after starting opioids.

Analysis showed that the prevalence of antipsychotic use was 13.3% six months before opioid imitation, 18.3% at initiation and 17.3% six months after, and the prevalence of benzodiazepine and related drug use was 27.1% six months prior, 28.9% at initiation and 26.9% six months after.

Following the start of the preopioid period, antipsychotic medication use rose by 0.7 percentage points (95% CI, 0.6-0.8) each month until opioid initiation. After accounting for the preopioid rate, the investigators found that the prevalence of antipsychotic and benzodiazepine and related drug use dropped by 0.3 (95% CI, 0.1-0.5) and 0.4 percentage points (95% CI, 0.2-0.7) each month until the end of the follow-up.

Initiation of opioids caused an immediate upsurge in prevalence — 1.9 percentage points for antipsychotics and 1.6 percentage points for benzodiazepine and related drug use — compared with participants who did not initiate opioids. In the post-opioid time segment, there was a slight reduction of 0.5 percentage points (95% CI, 0.3-0.8) each month for antipsychotic use and of 0.4 points (95% CI, 0.2-0.6) for benzodiazepine and related drug use until follow-up end.

“I'd say the most important take-home message of our and of previous research is that pain has to be taken into account when evaluating behavioral and psychological symptoms of dementia,” Hamina told Healio Psychiatry. “Treating pain seems to decrease the use of antipsychotics and benzodiazepines even on a nationwide level.” – by Savannah Demko

Disclosures: Hamina reports funding from the Tor, Joe and Pentti Borg Foundation. Please see the full study for all other authors’ relevant financial disclosures.