Prescription of long-acting opioid medications for chronic, noncancer pain is associated with an increased risk of all-cause mortality when compared to alternative medications, according to research published in JAMA.
Wayne A. Ray, PhD, Vanderbilt University School of Medicine, Nashville, and colleagues conducted a retrospective cohort study of Tennessee Medicaid patients with chronic, noncancer pain between 1999 and 2012. Patients had received either long-acting opioid therapy or comparable therapy with either an analgesic anticonvulsant or low-dose cyclic antidepressant. Patients had not received palliative or end-of-life care.
The researchers found 22,912 new episodes of prescribed therapy for both long-acting opioids and control medications; 185 deaths were recorded in the long-acting opioid group, compared to 87 deaths recorded in the control group. Data analysis showed that patients who were prescribed long-acting opioid therapy had a 1.6 times greater risk of all-cause mortality and a 1.9 times greater risk of out-of-hospital death.
“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,” noted Dr Ray. “These findings should be considered when evaluating harms and benefits of treatment.”
- Ray WA, Chung CP, Murray KT, et al. Prescription of long-acting opioids and mortality in patients with chronic noncancer pain. JAMA. 2016;315(22):2415-2423; doi: 10.1001/jama.2016.7789