Long-term Opioid Use Common in Alzheimer’s Patients, But Not Excessive, Finnish Study Says

A study led by Finnish researchers found that long-term use of opioids, painkillers that can be addictive, is common among people in that country with Alzheimer’s disease (AD), but at rates similar to people match by age, gender, and region of residence.

The study, “Long-term use of opioids for non-malignant pain among community-dwelling persons with and without Alzheimer’s disease in Finland: a nationwide register-based study,” was published online Nov. 4 in journal Pain.

Previous research has hinted that long-term use of antipsychotics and benzodiazepines is more common among people with AD. Here, researchers wanted to assess if this trend was also true for opioids. Moreover, the scientists evaluated if transdermal opioids, more commonly used among AD patients, would lead to long-term use more frequently.

“Neuropathological research has suggested a diminished perception of chronic pain in persons with AD and, in institutionalized patients with AD, analgesic use for chronic pain has been significantly less frequent compared to cognitively intact persons,” the researchers wrote. “However, whether these neuropathological changes translate to less frequent long-term opioid use for non-malignant pain among community-dwelling persons with AD is yet to be resolved.”

Investigators looked at 62,074 individuals in the Medication Use and Alzheimer’s Disease (MEDALZ) study, which included all community-dwellers diagnosed with Alzheimer’s in Finland during 2005 and 2011, and matched them with a similar group and number of people without Alzheimer’s. Patients under active cancer treatment were excluded.

They found 13,111 Alzheimer’s patients and 16,659 people without Alzheimer’s who used opioids. Overall, long-term opioid use — defined as use of more than or equal to 180 days —  was more common among those who were not Alzheimer’s patients (8.7% versus 7.2%). But among opioid users, the prevalence of long-term use was slightly higher among those with Alzheimer’s than among those without the disease (34.2% versus 32.3%).

Moreover, long-term use of transdermal opioids (delivered through the skin) was significantly — more than twofold — higher among people with Alzheimer’s who used opioids (13.2%) than among users without Alzheimer’s (5.5%).

In addition to AD, factors associated with long-term opioid use including being older than 80, being female, having rheumatoid arthritis or other pain-causing conditions, being of lower socioeconomic status, having a history of substance abuse, and having a history of long-term benzodiazepine (tranquilizer) use.

The researchers highlighted several strengths and limitations of the study, particularly the difficulty of drawing clinical conclusions from register-based data.

“Our results on long-term use of opioids among persons with AD are in line with those from previous study among the general population, where dementia was associated with low opioid discontinuation,” the researchers concluded. “Our results may also reflect the difficulty of pain assessment in chronic pain among persons with AD. Although assessment scales for pain in dementia have been developed, they are not comprehensively utilized in clinical practice.”

The results also “suggest a need for more frequent assessment of pharmacotherapy for cognitively impaired persons,” they said.