Long-acting opioids are associated with a significantly increased risk of death when compared with alternative medications for moderate-to-severe chronic pain, according to a Vanderbilt study released in the Journal of the American Medical Assocation (JAMA).
Not only did long-acting opioids increase the risk of unintentional overdose deaths, but they were also shown to increase mortality from cardiorespiratory events and other causes.
The story appeared in Vanderbilt University’s Research News @ Vanderbilt.
Lead author Wayne Ray, Ph.D., and colleagues with the Vanderbilt Department of Health Policy studied Tennessee Medicaid patients between 1999-2012 with chronic pain, primarily back and other musculoskeletal pain, who did not have cancer or other serious illnesses.
Researchers compared those starting a long-acting opioid to those taking an alternative medication for moderate-to-severe pain.
Alternative medications included both anticonvulsants — typically prescribed to prevent seizure activity in the brain, treat bipolar disorder or neuropathic pain — and low doses of cyclic antidepressants, which are taken for depression, some pain and migraines.
If a long-acting opioid is the only option for effective pain relief, patients should start with the lowest possible dose and only gradually increase it, he said.
The study group had a collective 22,912 new episodes of prescribed therapy for the medications, with 185 deaths in the long-acting opioid group and 87 deaths in the control group.
Long-acting opioid users had 69 excess deaths per 10,000 users. In other words, for every 145 patients who started a long-acting opioid, there was one excess death.
The study was supported by a grant from the National Heart, Lung, and Blood Institute, from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and by a grant from the Rheumatology Research Foundation.