Long-Acting Opioids Associated with Higher Mortality Risk Save

Prescription of long-acting opioids for chronic noncancer pain was associated with an increased risk of all-cause mortality, including deaths from causes other than overdose, compared with anticonvulsants or cyclic antidepressants, according to a study appearing in the June 14 issue of JAMA.

In a retrospective cohort study between 1999 and 2012, narcotic use among Tennessee Medicaid patients was assessed, specifically addressing cause-specific mortality.

The increase in prescribing opioid analgesics for chronic noncancer pain has led to escalating concern about potential harms. Long-acting opioids increase the risk of unintentional overdose deaths but also may increase mortality from cardiorespiratory and other causes. 

There were 22912 new episodes of prescribed long-acting opioids and control medications. The long-acting opioid group had 185 deaths and the control treatment group had 87 deaths.

The HR for total mortality was 1.64 (95% CI, 1.26-2.12) with a risk difference of 68.5 excess deaths (95% CI, 28.2-120.7) per 10 000 person-years. Increased risk was due to out-of-hospital deaths (HR 1.90).

The difference was explained by a 1.9 times greater risk of out-of-hospital deaths. More than two-thirds of the excess deaths were due to causes other than unintentional overdose; of these, more than one-half were cardiovascular deaths.

The risk of death was 4 fold higher in the first 30 days of therapy. Overall, the increased risk was higher to the first 180 days of prescribed therapy but was present for long-acting opioid doses of 60 mg or less of morphine-equivalents.

The authors warn that these findings should be considered when evaluating harms and benefits of using long-acting narcotics in the treatment of chronic, non-cancer pain.