800 Section - The burden of respiratory morbidity associated with opioid exposure among adults with cerebral palsy.

Chronic pain is one of the most commonly reported physical symptom of cerebral palsy (CP), and many people are prescribed opioids as a primary intervention for symptom management. The objective of this study was to examine the association between opioid exposure and risk of developing exacerbation of respiratory disorders among adults with CP.

Design:

This was a longitudinal U.S. cohort study of Medicare beneficiaries. Federally-insured beneficiaries were included if they had an ICD-9-CM/ICD-10-CM diagnosis code for CP (n= 32,303). Disorders of the respiratory system were examined for the entire cohort using a landmark analysis to account for temporality of the exposure with subsequent respiratory exacerbation.

Results:

The prevalence of any respiratory disorder was significantly higher among individuals exposed to opioids (61.6% vs. 37.2% p< 0.001), as well as across individual disorders, including for: pneumonia (34.3% vs. 17.8% p< 0.001), chronic lower respiratory diseases (38.5% vs. 21.6% p< 0.001), lung diseases due to external agents (19.2% vs. 9.7% p< 0.001), other respiratory diseases principally affecting the interstitium (7.2% vs. 2.1% p< 0.001), other diseases of the pleura (17.3% vs. 6.1% p< 0.001), other diseases of the respiratory system (39.5% vs. 18.6% p< 0.001) and respiratory multimorbidity (40.0% vs. 18.8% p< 0.001 p< 0.001). Fully adjusted hazard models demonstrated a robust association between high opioid exposures and exacerbation of respiratory disorders across all landmark analyses, ranging from HR: 1.45 (95%CI 1.28-1.63) to 1.63 (95%CI: 1.47-1.82).

Conclusion: Adults with CP have a high prescription prevalence of opioid exposure, and this is robustly associated with disorders of the respiratory system as well as exacerbation of respiratory disorders, longitudinally.