Hieu-Pham/cpgQA huggingface dataset:
Recommendations

In addition to benzodiazepines, the addition of other psychoactive medications to LOT must be made with  caution. While the evidence for harm associated with the combination of opioids and Z-drugs (e.g.,  zolpidem, eszopiclone) is not as strong as the evidence for harm associated with the combination of  opioids and benzodiazepines, we suggest not prescribing Z-drugs to patients who are on LOT, as moderate  quality evidence demonstrates that the combination of zolpidem and opioids increases the AOR of  overdose.[66] The evidence reviewed also identifies potential adverse outcomes (e.g., risk of overdose)  with the combined use of antidepressants and opioids in patients who do not have depression.[66] This  particular study did not differentiate between classes of antidepressants, limiting the ability of the Work  Group to recommend for or against prescribing opioids and a specific class of antidepressants. As such,  there is no recommendation in this guideline with respect to using specific classes of antidepressants and  LOT.  

Question: The combination of zolpidem and opioids increases what?
Answer: the AOR of  overdose
Recommendations

In addition to benzodiazepines, the addition of other psychoactive medications to LOT must be made with  caution. While the evidence for harm associated with the combination of opioids and Z-drugs (e.g.,  zolpidem, eszopiclone) is not as strong as the evidence for harm associated with the combination of  opioids and benzodiazepines, we suggest not prescribing Z-drugs to patients who are on LOT, as moderate  quality evidence demonstrates that the combination of zolpidem and opioids increases the AOR of  overdose.[66] The evidence reviewed also identifies potential adverse outcomes (e.g., risk of overdose)  with the combined use of antidepressants and opioids in patients who do not have depression.[66] This  particular study did not differentiate between classes of antidepressants, limiting the ability of the Work  Group to recommend for or against prescribing opioids and a specific class of antidepressants. As such,  there is no recommendation in this guideline with respect to using specific classes of antidepressants and  LOT.  

Question: What can happen with the combined use of antidepressants and opioids in patients who do not have depression?
Answer: potential adverse outcomes (e.g., risk of overdose)
Recommendations

In addition to benzodiazepines, the addition of other psychoactive medications to LOT must be made with  caution. While the evidence for harm associated with the combination of opioids and Z-drugs (e.g.,  zolpidem, eszopiclone) is not as strong as the evidence for harm associated with the combination of  opioids and benzodiazepines, we suggest not prescribing Z-drugs to patients who are on LOT, as moderate  quality evidence demonstrates that the combination of zolpidem and opioids increases the AOR of  overdose.[66] The evidence reviewed also identifies potential adverse outcomes (e.g., risk of overdose)  with the combined use of antidepressants and opioids in patients who do not have depression.[66] This  particular study did not differentiate between classes of antidepressants, limiting the ability of the Work  Group to recommend for or against prescribing opioids and a specific class of antidepressants. As such,  there is no recommendation in this guideline with respect to using specific classes of antidepressants and  LOT.  

Question: What can have potential adverse outcomes in patients who do not have depression?
Answer: the combined use of antidepressants and opioids
Recommendations

In addition to benzodiazepines, the addition of other psychoactive medications to LOT must be made with  caution. While the evidence for harm associated with the combination of opioids and Z-drugs (e.g.,  zolpidem, eszopiclone) is not as strong as the evidence for harm associated with the combination of  opioids and benzodiazepines, we suggest not prescribing Z-drugs to patients who are on LOT, as moderate  quality evidence demonstrates that the combination of zolpidem and opioids increases the AOR of  overdose.[66] The evidence reviewed also identifies potential adverse outcomes (e.g., risk of overdose)  with the combined use of antidepressants and opioids in patients who do not have depression.[66] This  particular study did not differentiate between classes of antidepressants, limiting the ability of the Work  Group to recommend for or against prescribing opioids and a specific class of antidepressants. As such,  there is no recommendation in this guideline with respect to using specific classes of antidepressants and  LOT.  

Question: Who can have potential adverse outcomes with the combined use of antidepressants and opioids?
Answer: patients who do not have depression
Recommendations

a) We recommend against long-term opioid therapy for patients less than 30 years of age  secondary to higher risk of opioid use disorder and overdose. (Strong against) b) For patients less than 30 years of age currently on long-term opioid therapy, we recommend  close monitoring and consideration for tapering when risks exceed benefits (see Recommendation  14 and Recommendation 17). (Strong for) (Reviewed, New-replaced)  

Question: What is the stance regarding long-term opioid therapy for patients less than 30 years of age  secondary to higher risk of opioid use disorder and overdose?
Answer: recommend against
Recommendations

a) We recommend against long-term opioid therapy for patients less than 30 years of age  secondary to higher risk of opioid use disorder and overdose. (Strong against) b) For patients less than 30 years of age currently on long-term opioid therapy, we recommend  close monitoring and consideration for tapering when risks exceed benefits (see Recommendation  14 and Recommendation 17). (Strong for) (Reviewed, New-replaced)  

Question: What is recommended for patients less than 30 years of age currently on long-term opioid therapy?
Answer: close monitoring and consideration for tapering when risks exceed benefits
Recommendations

All patients who take opioids chronically are at risk for OUD and overdose, but especially those who are  younger than 30 years of age. Seven studies were identified that examined age as a predictor of OUD,  respiratory/CNS depression, and/or overdose. Four of the seven studies were rated as fair quality  evidence,[59,86,88,92] while three were rated as poor quality evidence.[58,62,87] Six of the seven studies  demonstrated that age was inversely associated with the risk of OUD and overdose.[59,62,86-88,92] One  of the three low quality studies showed that older subjects had a higher HR of overdose.[58] The Work  Group’s overall confidence in the quality of the evidence was moderate.  

Question: Who are at risk for OUD and overdose?
Answer: All patients who take opioids chronically
Recommendations

All patients who take opioids chronically are at risk for OUD and overdose, but especially those who are  younger than 30 years of age. Seven studies were identified that examined age as a predictor of OUD,  respiratory/CNS depression, and/or overdose. Four of the seven studies were rated as fair quality  evidence,[59,86,88,92] while three were rated as poor quality evidence.[58,62,87] Six of the seven studies  demonstrated that age was inversely associated with the risk of OUD and overdose.[59,62,86-88,92] One  of the three low quality studies showed that older subjects had a higher HR of overdose.[58] The Work  Group’s overall confidence in the quality of the evidence was moderate.  

Question: Which patients are especially at risk for OUD and overdose?
Answer: those who are  younger than 30 years of age
Recommendations

All patients who take opioids chronically are at risk for OUD and overdose, but especially those who are  younger than 30 years of age. Seven studies were identified that examined age as a predictor of OUD,  respiratory/CNS depression, and/or overdose. Four of the seven studies were rated as fair quality  evidence,[59,86,88,92] while three were rated as poor quality evidence.[58,62,87] Six of the seven studies  demonstrated that age was inversely associated with the risk of OUD and overdose.[59,62,86-88,92] One  of the three low quality studies showed that older subjects had a higher HR of overdose.[58] The Work  Group’s overall confidence in the quality of the evidence was moderate.  

Question: All patients who take opioids chronically are at risk for what?
Answer: OUD and overdose
Recommendations

All patients who take opioids chronically are at risk for OUD and overdose, but especially those who are  younger than 30 years of age. Seven studies were identified that examined age as a predictor of OUD,  respiratory/CNS depression, and/or overdose. Four of the seven studies were rated as fair quality  evidence,[59,86,88,92] while three were rated as poor quality evidence.[58,62,87] Six of the seven studies  demonstrated that age was inversely associated with the risk of OUD and overdose.[59,62,86-88,92] One  of the three low quality studies showed that older subjects had a higher HR of overdose.[58] The Work  Group’s overall confidence in the quality of the evidence was moderate.  

Question: How many studies examined age as a predictor of OUD,  respiratory/CNS depression, and/or overdose?
Answer: Seven
Recommendations

Similar to other risk factors, age <30 years should be weighed heavily in the risk-benefit determination for  initiating LOT. Age <30 years is not an absolute contraindication to LOT. There may be some situations  where the benefits of LOT clearly outweigh the risks of OUD and overdose. Hospitalized patients  recovering from battlefield injuries, for example, are known to have less chronic pain, depression, and  PTSD when their pain is aggressively managed starting soon after injury.[93] In those cases, LOT may be  appropriate only if risk mitigation strategies are employed and patients are titrated off LOT as soon as it is  appropriate (see Recommendations 14 and 15). 

Question: What should be weighed heavily in the risk-benefit determination for initiating LOT?
Answer: Similar to other risk factors, age <30 years
Recommendations

Similar to other risk factors, age <30 years should be weighed heavily in the risk-benefit determination for  initiating LOT. Age <30 years is not an absolute contraindication to LOT. There may be some situations  where the benefits of LOT clearly outweigh the risks of OUD and overdose. Hospitalized patients  recovering from battlefield injuries, for example, are known to have less chronic pain, depression, and  PTSD when their pain is aggressively managed starting soon after injury.[93] In those cases, LOT may be  appropriate only if risk mitigation strategies are employed and patients are titrated off LOT as soon as it is  appropriate (see Recommendations 14 and 15). 

Question: What is not an absolute contraindication to LOT?
Answer: Age <30 years
Recommendations

Similar to other risk factors, age <30 years should be weighed heavily in the risk-benefit determination for  initiating LOT. Age <30 years is not an absolute contraindication to LOT. There may be some situations  where the benefits of LOT clearly outweigh the risks of OUD and overdose. Hospitalized patients  recovering from battlefield injuries, for example, are known to have less chronic pain, depression, and  PTSD when their pain is aggressively managed starting soon after injury.[93] In those cases, LOT may be  appropriate only if risk mitigation strategies are employed and patients are titrated off LOT as soon as it is  appropriate (see Recommendations 14 and 15). 

Question: Who are known to have less chronic pain, depression, and  PTSD when their pain is aggressively managed starting soon after injury?
Answer: Hospitalized patients  recovering from battlefield injuries
Recommendations

Similar to other risk factors, age <30 years should be weighed heavily in the risk-benefit determination for  initiating LOT. Age <30 years is not an absolute contraindication to LOT. There may be some situations  where the benefits of LOT clearly outweigh the risks of OUD and overdose. Hospitalized patients  recovering from battlefield injuries, for example, are known to have less chronic pain, depression, and  PTSD when their pain is aggressively managed starting soon after injury.[93] In those cases, LOT may be  appropriate only if risk mitigation strategies are employed and patients are titrated off LOT as soon as it is  appropriate (see Recommendations 14 and 15). 

Question: When may LOT be appropriate?
Answer: only if risk mitigation strategies are employed and patients are titrated off LOT as soon as it is  appropriate
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Who have an added great risk for OUD and overdose?
Answer: younger patients using opioids
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Who did carry 11 times the odds of OUD and overdose compared to patients ≥65 years old?
Answer: patients 18-30 years old
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Compared to whom, patients 18-30 years old carried 11 times the odds of OUD  and overdose?
Answer: patients ≥65 years old
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Compared to patients ≥65 years old, patients 18-30 years old carried how many times the odds of OUD  and overdose?
Answer: 11
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Who did carry 5 times the odds of OUD and overdose compared to patients ≥65 years old?
Answer: Patients 31-40 years
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Compared to whom, patients 31-40 years old carried 5 times the odds of OUD and overdose?
Answer: those  ≥65 years old
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Compared to patients ≥65 years old, patients 31-40 years old carried how many times the odds of OUD  and overdose?
Answer: 5
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Who had roughly half the risk of developing OUD or overdose compared to subjects 18-29 years old?
Answer: patients 30-39  years old
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Compared to whom, patients 30-39  years old had roughly half the risk of developing OUD or overdose?
Answer: subjects 18-29 years old
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: What was the amount of risk of developing OUD or overdose in patients 30-39  years old compared to subjects 18-29 years old?
Answer: roughly half
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Who had far less risk of developing OUD or overdose compared to subjects 18-29 years old?
Answer: patients ≥70 years old
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: Compared to whom, patients ≥70 years old had far less risk of developing OUD or overdose?
Answer: subjects 18-29 years old
Recommendations

The added risk that younger patients using opioids face for OUD and overdose is great. Edlund et al. (2014)  found that, compared to patients ≥65 years old, patients 18-30 years old carried 11 times the odds of OUD  and overdose. Patients 31-40 years old carried 5 times the odds of OUD and overdose compared to those  ≥65 years old.[86] Bohnert et al. (2011) found that, compared to subjects 18-29 years old, patients 30-39  years old had roughly half the risk of developing OUD or overdose (HR: 0.56, 95% CI: 0.27-1.17). Compared  to the subjects 18-29 years old, patients ≥70 years old had a far less risk (nearly 1/17) of developing OUD  or overdose (HR: 0.06, 95% CI: 0.02, 0.18).[59]  

Question: What was the amount of risk of developing OUD or overdose in patients ≥70 years old compared to subjects 18-29 years old?
Answer: far less risk (nearly 1/17)
Recommendations

Younger patients are also at a higher risk of opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior). Turner et al. (2014) showed that patients in the 45-64 year age group were  significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to patients in the 20-44 age  group.[94] Patients in the 45-64 and ≥65 age groups were significantly less likely than 20-44 year olds to  have non-detection of a prescribed opioid as well (indicating possible diversion).[94]  

Question: Who are at a higher risk of opioid misuse?
Answer: Younger patients