Long-acting opioids are prescribed more and more for non-cancer related pain, even though the risk of overdose is high. A new study shows the risks of these medications extend far beyond the heightened chance of death by accidental overdose.
The study appeared last month in JAMA. It followed patients prescribed long-acting opioids for chronic pain in the back, abdomen, muscles and head, as opposed to managing their pain with a different option. It reported that these patients had twice the risk of dying outside of the hospital. Of those deaths, more than two-thirds were from causes other than overdose, primarily heart problems.
The study is important for many reasons. The increased risk of death outside of a hospital shows that the patient was cleared of any potential fatal risks related to their primary condition. The comparison rate between hospitalized patients on long-acting opioids and those on other forms of medicine was not statistically different.
The study was expansive, examining 22,912 new episodes of prescribed therapy among Medicaid patients in Tennessee between 1999 and 2012. The sample size was 60 percent female and had a mean age of 48.
Those in the opioid group were most likely to be prescribed a type of morphine. Other opioids prescribed included controlled released oxycodone, transdermal fentanyl, and methadone.
The increased risk of death among the opioid group tapered off after the first 30 days and was no longer significant after six months.
“The long-acting opioid group was followed for an average of 176 days and had 185 deaths; the control group was followed for 128 days on average and had 87 deaths,” JAMA reported in a news release.
The study agrees with the U.S. Centers for Disease Control and Prevention about prescribing opioids for non-cancer pain. “Of primary importance, non-opioid therapy is the preferred treatment for chronic pain,” the CDC says.
Getting Off Opioids Is Possible, Even for the Addicted
For people addicted to opioids, there is medicine to help you wean yourself off the drug. Concurrent psychotherapy that addresses an someone’s troubles and worries, while teaching them new ways of coping and moving past their problems, can result in successful healing of even the most severely addicted. Group support such as a 12-Step group or other program can help maintain sobriety.
“The study finding that prescription of long-acting opioids was associated with increased cardiovascular and other non-overdose mortality adds to the already considerable known harms of the opioids and thus should be considered when assessing the benefits and harms of medications for chronic pain,” the authors concluded. “As the CDC guideline indicates, all prescribing decisions must be based on an evaluation of the source and severity of the patient’s pain and a discussion of the ‘known risks and realistic benefits’ of opioid therapy.”
Some doctors may not discuss the potential for addiction with patients. Especially those who they believe may not be at risk or who would be offended by the question. However, it’s important to remember that drug dependence doesn’t discriminate and is not a moral failing. If you’re concerned about the quality of your drug therapy, ask your doctor if the risks are outweighing the benefits.
The authors noted the study does have some limits. For some people, opioids are the right choice for chronic pain.
The study relied on “the death certificate to classify the cause of death, thus raising the possibility that the cardiovascular death finding was due to misclassification,” the authors wrote. A sampling of medical records showed that any misclassifications were unlikely at best but statistically insignificant at worst. “Furthermore, more than two-thirds of the excess deaths for patients in the long-lasting opioid group were not coded as being due to unintentional overdose. If there is this degree of misclassification, then previous research on opioid mortality, most of which has focused on overdose deaths identified from death certificates, has substantially underestimated the true risks of opioids.”
This is a staggering thought given the nation’s snowballing opioid epidemic.
Ray, W. et al. Prescription of Long-Acting Opioids and Mortality in Patients with Chronic Noncancer Pain. (2016, June 14). JAMA. Retrieved July 1, 2016, from http://jama.jamanetwork.com/article.aspx?articleid=2528212
Written by David Heitz