Could Long-Acting Opioids Increase CV Mortality Risk?

Use of long-acting opioids for chronic noncancer pain is associated with increased risk of all-cause and cardiovascular mortality, according to the results of a recent study.

While the use of long-acting opioids has been shown to increase unintentional overdose death risk, its effect on all-cause and cardiovascular mortality risk is less certain.
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To examine the association, the researchers conducted a retrospective cohort study between 1999 and 2012 of Medicaid patients with chronic noncancer pain. Analgesic anticonvulsants and low-dose cyclic antidepressants were used as control medications.

Overall, there were 22,912 new episodes of prescribed therapy for long-acting opioids, matched with 22,912 episodes of control medication. There were 185 deaths in the opioids group and 87 deaths in the control group. There were 164.1 deaths per 10,000 person-years in the opioid group, compared with 107.9 per 10,000 person-years in the control group.

After adjusting the data, the researchers found that opioid use was associated with a 72% increase in the risk of all-cause mortality other than from unintentional overdose and a 65% increase in the risk of cardiovascular mortality.

“Prescription of long-acting opioids for chronic noncancer pain, compared with anticonvulsants or cyclic antidepressants, was associated with a significantly increased risk of all-cause mortality, including deaths from causes other than overdose, with a modest absolute risk difference. These findings should be considered when evaluating harms and benefits of treatment,” the researchers concluded.

—Michael Potts

Reference:
Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Prescription of long-acting opioids and mortality in patients with chronic noncancer pain. JAMA. 2016;315(22):2415-2423.