• Casey León, Minhee L Sung, Joel I Reisman, Weisong Liu, Robert D Kerns, Kirsha S Gordon, Avijit Mitra, Sunjae Kwon, Hong Yu, William C Becker, and Wenjun Li.
• Department of Public Health and Center for Health Statistics, University of Massachusetts Lowell, Lowell, MA, USA.
• Clin J Pain. 2024 Dec 17.

ObjectiveNeurocognitive symptoms (NCS) may be early indicators of opioid-related harm. We aimed to evaluate the incidence and potential attribution of opioid-related NCS among patients on long-term opioid therapy (LTOT) by using natural language processing (NLP) to extract data from the electronic health records (EHR) within the Veterans Health Administration.MethodsWe conducted a retrospective cohort study of patients prescribed LTOT in 2018. NCS were identified from clinical notes across three periods: 6 months prior to LTOT initiation, during LTOT, and one-year post- LTOT discontinuation. Opioid-related NCS included cognitive impairment, sedation, light-headedness, altered mental status, and intoxication. We calculated incidence rates, incidence rate ratios (IRRs), and hazard ratios (HR) to evaluate the occurrence and potential opioid attribution of NCS across these periods.ResultsAmong 55,652 patients, 3.1% experienced opioid-related NCS, with the highest incidence observed during LTOT. Prevalence of NCS was greater in patients who were: between 55 and 64 (3.6%) or 65 and 74 years old (3.2%), Asian (4.8%, P=0.02), and had received treatment for substance use disorders (7.1%, P=0.01). In adjusted proportional hazards models, identified Asian race (HR 2.20, 95% CI [1.09-4.44], P=0.03), and co-occurring conditions dementia (1.50 [1.12-2.00], 0.01), depression (1.31 [1.14-1.49], 0.01), post-traumatic stress disorder (1.18 [1.02-1.37], 0.02), substance use disorder (1.62 [1.36-1.92], 0.01), cardiovascular disease (1.18 [1.01-1.37], 0.04), chronic obstructive pulmonary disease (1.16 [1.01-1.33], 0.03), cirrhosis (1.73 [1.34-2.24], 0.01), chronic kidney disease (1.41 [1.19, 1.66]; 0.01) and traumatic brain injury (1.42 [1.06-1.91], 0.02) were associated with increased likelihood of NCS. Likelihood of NCS increased with LTOT dose and decreased with LTOT duration.DiscussionThis study suggests that opioid-related NCS are most likely to occur during LTOT, indicating a potential temporal association with opioid use. These findings highlight the importance of monitoring NCS in patients on LTOT as part of a broader strategy to mitigate opioid-related harms.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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