Risk of Death from Long-Acting Prescription Opioids (LAOs) Goes Far Beyond Overdose, Says New Study

Risk of Death from Long-Acting Prescription Opioids (LAOs) Goes Far Beyond Overdose, Says New Study

A new study shows that long-acting prescription opioids (LAOs) not only increase the risk of unintentional overdose deaths, but also increase mortality from heart-related and other causes of death. In other words, we’ve put a lot of attention on the potential for opioid overdoses, without realizing that the painkillers are also causing even more deaths for other reasons. “As bad as people think the problem of opioid use is, it’s probably worse,” said Wayne Ray, Ph.D., the lead author and a health policy professor at Vanderbilt University School of Medicine. “They should be a last resort and particular care should be exercised for patients who are at cardiovascular risk.” The study, published in the Journal of the American Medical Association (JAMA), compared the death rates of more than 45,000 adult Medicaid patients in Tennessee, from 1999 to 2012. The patients included low-income and disabled adults who are among the groups in the general population disproportionately affected by opioid abuse. Dr. Ray added that the sickest patients and those with any evidence of drug abuse were excluded from the study.

Patients similar in all respects

The patients were all being treated for similar chronic noncancer pain, such as persistent backaches or arthritis. Roughly half received long acting opioids, such as extended-release oxycodone, methadone and fentanyl skin patches. The “control” half were taking non-opioid pain drugs such as the anticonvulsant gabapentin, often prescribed for various kinds of nerve pain, and certain antidepressants also used for pain. As Modern Healthcare reported, “the two groups were similar in age, medical conditions, risks for heart problems and other characteristics that could have contributed to the outcomes.” Keeping those similarities in mind, here are the startling results:

  1. The long-acting opioid group had 185 deaths, while the control group – similar in every way but not taking opioids – suffered only 87 deaths.
  2. Those taking LAOs had a 64 percent higher risk of dying within six months of starting treatment compared to patients taking the other prescription medicines.
  3. Unintentional overdoses accounted for only 18 percent of the deaths among the LAO users versus 8 percent of the other patients.
One would expect accidental overdoses to be higher among opioid users than among the control group drugs. But only 18 percent of those who died were from overdose? What happened to the other 82 percent of the opioid patients who died?

LAOs the Incriminating Factor

The only factor that differentiated the two groups of patients is the use of long-acting opioids in one and not in the other. And therein lies the evidence that much more needs to be known about the effects of long-acting opioids that contribute to all-cause mortality. Modern Healthcare’s coverage of this study points out that Dr. Ray said that similar results to this study would likely be found in other groups. And his caution to prescribers of long-acting opioids “echoes recent advice from the Centers for Disease Control and Prevention trying to stem the nation’s opioid epidemic.” Street and prescription opioids alike can cause overdose death – depress the central nervous system, slow breathing, cause unconsciousness and death. But they also can worsen the disrupted breathing that occurs with sleep apnea, potentially leading to irregular heartbeats, heart attacks or sudden death, the study authors said. These are not overdose deaths, they are opioid-induced or opioid-related mortalities. Which is why prescribers should be more prudent with their prescribing. There were 14,000-plus fatal overdoses linked with prescription opioid painkillers in the U.S. in 2014. But the study suggests a broader look at what constitutes opioid-related death. According to the study, it is very likely that even more have died from the side effects of opioids, bolstering the evidence from this study and previous research linking opioids to aggravating existing heart problems.

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