Association Between Gabapentinoid Use and Changes in Claims-Based Frailty Among Long-Term Opioid Users

Objective: Assess the association of opioids and gabapentinoids with changes in frailty among Medicare beneficiaries who used opioids for 90 or more consecutive days. Methods: Using a Medicare sample between 2014 and 2020, this study included long-term opioid users who were eligible for Medicare parts A, B, and D for 3 years and had no prior gabapentinoid use. The study was broken into three 1-year periods: lookback, exposure, and outcome. The exposure of interest was gabapentinoid and opioid use measured in period 2. The primary outcome was difference in frailty between periods 1 and 3. Linear regression was used to assess the difference in frailty change by gabapentinoid and opioid use. Multinomial regression was also used to assess the odds of categorical frailty change by gabapentinoid and opioid use. Results: Overall, the changes in frailty between assessment periods were small. Those who had no continued opioid/no gabapentinoid use showed decreases in frailty (− 0.0005), while each of the other three groups increased in frailty between the assessment periods (opioids only, 0.0040; gabapentinoids only, 0.0136; opioids + gabapentinoids, 0.0142). In addition, each of the drug groups showed increased odds for large increases in frailty compared with those who had no continued opioid/no gabapentinoid use (opioids only, odds ratio (OR): 1.25, 95% confidence interval (CI) 1.04–1.49; gabapentinoids only, OR: 3.12, 95% CI 1.75–5.55; opioids + gabapentinoids, OR: 2.30, 95% CI 1.85–2.87). Conclusions: Using gabapentinoids, opioids, or a combination of the two showed greater increases in frailty compared with those who used neither drug after long-term opioid use.