HealthDay News – The use of long-acting opioids for the treatment of chronic, noncancer pain was found to be associated with increased all-cause mortality rates as compared to treatment with anticonvulsants or low-dose cyclic antidepressants, according to a study published in the Journal of the American Medical Association.
Wayne Ray, PhD, from the department of health policy at the Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues analyzed data collected between 1999 and 2012 on 22 912 patients, average age 48, who had been prescribed a long-acting opioid medication. The researchers compared that to data on an equal number of patients who had been given an alternate pain medication, including anticonvulsants and low-dose cyclic antidepressants.
High Yield Data Summary
- Long-acting opioid use for chronic noncancer pain was associated with a total mortality HR of 1.64 (95% CI, 1.26-2.12), representing a risk difference of 68.5 excess deaths (95% CI, 28.2-120.7) per 10 000 patient years
During an average tracking period of about four to six months, there were 185 deaths in the opioid group versus 87 deaths in the alternate medication group. In all, the opioid group was found to face a 64% increased risk of death due to any reason, the team found. But the opioid patients also faced a 65% increased risk of death specifically related to new cardiovascular complications.
The study authors concluded that alternate pain medications should be favored over long-acting opioids whenever possible, particularly for those patients who have a history of cardiovascular disease, heart attack, or diabetes.
“Our opinion, which is consistent with the recent guidelines from the U.S. Centers for Disease Control and Prevention, is that opioids should be used as a last resort,” Ray told HealthDay. “The best way to decide if the benefits outweigh the risks is through a careful practitioner-patient discussion.”
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.