Recent research suggests that opioid use is associated with increased risk for severe respiratory side effects, including death, among older adults with chronic obstructive pulmonary disease (COPD).
The study, “Incident opioid drug use and adverse respiratory outcomes among older adults with COPD,” was published in the European Respiratory Journal.
For the study, researchers from St. Michaels Hospital, in Canada, led by Dr. Nicholas Vozoris, used databases from the Institute for Clinical Evaluative Sciences to examine clinical records from April 1, 2007 to March 31, 2012, on more than 130,000 COPD patients, ages 66 years and older. Among them, 68.2% received an opioid treatment.
Researchers found that the risk for respiratory-related death was five times higher for new opioid users compared to non-opioid users. These results raised serious safety concerns about the use of opioids for older adults with COPD.
“Previous research has shown about three-quarters of older adults with COPD have been prescribed opioids, which is an incredibly high rate of new use in a population that is potentially more sensitive to narcotics,” said Vozoris in a news release. “Our new findings show there are not only increased risks for respiratory-related death associated with new opioid use, but also increased risk of visits to emergency rooms, hospitalizations and needing antibiotics or steroid pills.”
Opioids may be prescribed to patients with COPD for reasons various reasons such as chronic musculoskeletal pain, insomnia and refractory respiratory symptoms — all of which are common in COPD.
“This is a population that has a chronic lung disease, with symptoms that can sometimes be challenging to manage,” Vozoris said. “This class of drugs may offer some relief; however, there is also evidence suggesting that opioids can adversely affect breathing and lung health in people who already have chronically compromised lungs.”
Opioids can impact COPD patients several ways: respiratory depression, reduced mucous clearance from cough suppression, and immunosuppressive effect. To lower the risks of adverse events, clinicians prescribe less potent or lower dosage opioids — but the results of the current study showed increased risk of complications and even death regardless of dose amount among new opioid users.
Vosoriz said the finding is important because lower doses were long considered safe.
The new study suggests that a careful, individualized approach should be taken when administering opioids, despite current guidelines that recommend the use of opioids to manage respiratory symptoms that are difficult to control.
“Sometimes patients are looking for a quick fix for chronic pain or breathing issues and physicians may believe opioids can offer them some relief,” Vozoris said. “The trade-off becomes explaining that there are risks to patients and making sure they understand that potentially alleviating their symptoms could come at a higher cost to their health.”
In Canada, COPD affects about four to 10% of the population and has a five-year mortality rate from 40 to 70%, depending on disease severity. The two-year mortality rate for COPD patients with severe disease is approximately 50%.