Long-Acting Opioids Tied to Increased Mortality Unrelated to Overdose

Edited by Susan Sadoughi, MD

Use of long-acting opioids for chronic noncancer pain is associated with increased risk for all-cause and cardiovascular mortality, suggests a retrospective study in JAMA.

Using Tennessee Medicaid data from 1999 through 2012, researchers matched nearly 23,000 new instances of long-acting opioid prescriptions with 23,000 episodes of control medication prescriptions (analgesic anticonvulsants or low-dose cyclic antidepressants). Matching took into account 122 covariates, including demographics and diagnoses.

There were 167.1 deaths per 10,000 person-years during opioid treatment versus 107.9 per 10,000 during control treatment. In adjusted analyses, opioids were associated with a 72% increased risk for death from causes other than unintentional overdose and with a 65% increased risk for cardiovascular death in particular.

Dr. Thomas Schwenk of NEJM Journal Watch General Medicine commented: “Retrospective cohort studies, even one controlling for 122 covariates, cannot prove causation. However, these results are consistent with clinician experience and observation and add to the concern about long-acting opioid use.”