This is for our readers who treat chronic pain patients along with those who perform an anesthetic on chronic pain patients.
Receiving an opioid prescription is linked with higher risks of death and hospitalisation compared with receiving other pain medications, and the risk of death is especially high in individuals with lower kidney function, according to a study published in the Clinical Journal of the American Society of Nephrology.
When individuals with chronic kidney disease (CKD) are in need of pain medications, opioids are often prescribed due to concerns of kidney toxicity from other medications such as non-steroidal anti-inflammatory drugs (NSAIDs). However, because opioids are excreted by the kidney, people with CKD may experience higher exposure to the active compounds of opioids because of less clearance from the body. To date, few studies have quantified the safety of prescription opioids across different levels of kidney function.
For the current study, Tessa Novick, MD, Johns Hopkins University, Baltimore, Maryland, and colleagues examined information on deaths and hospitalisations among adult primary care patients in the Geisinger Health System of Pennsylvania between 2008 and 2017. The analysis included 23,123 patients who received opioids and the same number who received NSAIDs.
The researchers found that prescriptions for 1 to 59 and ≥60 daily oral morphine milligram equivalents [MMEs] were associated with a higher risk of death (hazard ratio [HR] = 1.70; 95% confidence interval [CI], 1.41-2.05 for 1 to 59 MMEs and HR = 2.25; 95% CI, 1.82-2.79 for ≥60 MMEs) and hospitalisation (HR = 1.38; 95% CI, 1.30-1.46 for 1 to 59 MMEs and HR = 1.68; 95% CI, 1.56-1.81 for ≥60 MMEs) compared with NSAID prescriptions.
The relative risk of death associated with ≥60 MMEs was higher for those with a lower glomerular filtration rate.
When gabapentinoids were used as the comparison medication, only ≥60 MMEs were significantly associated with higher risk of death (HR = 2.72; 95% CI, 1.71-4.34), although both 1 to 59 and ≥60 MMEs were associated with risk of hospitalisation (HR = 1.22; 95% CI, 1.04- 1.43 for 1 to 59 MMEs and HR = 1.54; 95% CI, 1.28-1.86 for ≥60 MMEs).
“We found that receipt of prescription opioids was associated with a higher risk of death and hospitalisation compared with other pain medications, particularly with higher doses,” concluded Dr. Novick. “The risk of death was highest among people with lower kidney function.”