Long-Acting Opioids Are the Deadliest of Chronic Pain Treatment Options

JUNE 16, 2016
Caitlyn Fitzpatrick
rheumatology, pain management, addiction medicine, chronic pain, opioids, prescription drugs, pharmacyThis probably won’t come as shocking news, but long-acting opioids significantly increase the risk of death compared to other pain therapy options.

Prescription drug addiction is an ongoing problem within various healthcare specialties. The problem isn’t one-sided, but instead is an issue that must be addressed by both physicians and patients. However, when someone is suffering from chronic pain, it may seem like opioids are a quick fix. Addiction, and even death, are serious consequences that can ensue from beginning a prescription. Researchers from the Vanderbilt University’s Department of Health Policy in Nashville, Tennessee, found just how much these pain pills contribute to mortality and cardiorespiratory events.

“We knew opioids increase the risk of overdose. However, opioids can interfere with breathing during the night, which can cause heart arrhythmias,” lead author Wayne Ray, PhD, said in a news release.

The team analyzed patients starting long-active opioids or other medication for moderate-to-severe pain. The other medication included anticonvulsants – used for neuropathic pain, bipolar disorder, and seizures – and low doses of cyclic antidepressants – used for depression but also for some pain and migraines. Out of the 22,912 new prescriptions for the patient cohort, there were 185 deaths in the long-acting opioid group and 87 deaths in the other medication group. To put this in perspective, there was one death for every 145 people using opioids, according to the results published in The Journal of the American Medical Association (JAMA).

Notably, none of these patients were being treated for cancer pain or end-of-life pain. The cohort was 60% female and there was an average age of 48.

“We found that opioid patients had a 64% increased risk of death for any reason and a 65% increased risk of cardiovascular death,” continued Ray, a professor of Health Policy at Vanderbilt University School of Medicine.

This means that patients who have diabetes or a history of heart attack should especially avoid long-acting opioids.

But that’s not all that the researchers found. As Ray explained, “Data are limited as to the best medicine for the kinds of pain we studied, such as back pain, although for pain involving the nerves, the non-opioids may be better. For less severe pain, many over-the-counter medications such as ibuprofen or naproxen, may be as effective as an opioid.”

Frankly, there is no one pill fits all when it comes to pain. What works for one patient for one type of pain may not benefit another patient. However, something that everyone can take away from these findings is that it would be smart to avoid long-acting opioids if possible.

“Because most patient populations have more cardiovascular deaths than overdose deaths, our finding means that prior studies may have underestimated the harms of long-acting opioids,” Ray concluded.

Also on MD Magazine >>> Opioid Addiction: It Happens to Physicians Too

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