Prescription opioid use is linked to an elevated risk for invasive pneumococcal disease (IPD), according to a study published in the Annals of Internal Medicine.

Andrew D. Wiese, PhD, of the Department of Health Policy at Vanderbilt University Medical Center in Nashville, and associates conducted a nested case-control investigation to determine if prescription opioid use is independently associated with a risk for IPD.

Volunteers included patients aged 5 years and older with confirmed cases of IPD (n=1233) and control group patients matched by diagnosis date, age, and region of residence (n=24,399).

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The investigators reported that patients with IPD had a greater odds ratio of opioid usage compared with the control participants (adjusted odds ratio [aOR], 1.62). The most robust correlation was observed for patients taking long-acting high-potency opioids when compared with remote use (aOR, 1.87; 1.72, respectively). Short-acting opioids were also associated with IPD (aOR, 1.58).

Doses of 50 morphine milligram equivalents (MME) or more has the greatest odds ratios: 50 to 90 MME aOR, 1.71 and ≥90 MME aOR, 1.75. Opioid use was compared with both pneumonia and nonpneumonia IPD risks (aOR, 1.54 and 1.94, respectively).

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“These findings should be considered when developing IPD prevention recommendations, including vaccination,” reported the authors. “Because the strongest associations were observed for opioids with certain characteristics, these findings should be considered when selecting opioid analgesics for pain management.


  1. Wiese AD, Griffin MR, Schaffner W, et al. Opioid analgesic use and risk for invasive pneumococcal diseases: A nested case-control study. Ann Intern Med.  2018 Feb 13. doi:10.7326/M17-1907 [Epub ahead of print].