Chronic opioid therapy is a risky one with a new study suggesting that such a therapy increases the risk of death from overdose with men at much higher risk than women.
According to a new study from Institute for Clinical Evaluative Sciences (ICES), Canada, based on data from over quarter of a million people in Ontario, escalation to high-dose therapy and opioid-related death in patients on chronic opioid therapy have reached striking levels and this calls for importance of thinking twice before embarking on chronic opioid therapy.
Researchers found that one in ever 350 men and 1 in ever 850 men receiving chronic opioid therapy died due to overdose. Researchers also established that relative to women, men were almost 50 per cent more likely to escalate to high-dose opioids and twice as likely to die from opioid-related causes.
The 1 in 350 and 1 in 850 might not sound too huge numbers, but when considering that tens of millions of patients are on such therapies, the people at risk immediately reaches alarming levels.
With more than 1 of every 10 patients prescribed opioids for the first time becoming chronic users, in patients receiving chronic opioid therapy (longer than 3 months), roughly 1 of every 45 men and 1 of every 70 women escalated to high dose therapy (greater than 200 mg morphine or equivalent per day).
The study also fund tha tpatients who escalated to high dose opioid therapy were nearly 24 times as likely to die as those who did not escalate.
The study, published in the journal PLOS ONE, saw researchers examine records of 285,520 individuals in Ontario receiving opioid treatment over a 13-year period. According to researchers this is the first large-scale study to confidently assess the risk of overdose death during treatment with chronic opioid therapy.
Researchers note that opioid deaths now represent more than 40 per cent of all mortality from poisoning in North America today, outnumbering deaths from alcoholic liver disease and HIV.
“Men were twice as likely as women to escalate to high-dose therapy and twice as likely to die from opioid-related causes,” says the study’s senior author and ICES senior scientist Dr. David Juurlink, who is also the head of the Division of Clinical Pharmacology and Toxicology at the University of Toronto. “But even more striking were the overall rates of escalation in both sexes to high-dose therapy and opioid-related death in patients on chronic opioid therapy. Both of these were far higher than we expected, and will likely come as a surprise to many physicians and patients.”
“These findings underscore the importance of thinking twice before embarking on chronic opioid therapy, and particularly high-dose therapy.” says Juurlink. “Physicians who opt to prescribe chronic opioid therapy should appreciate these risks, and should ensure their patients understand them too.”
Despite their very widespread use, the researchers say there is little evidence supporting the safety and effectiveness of long-term opioid therapy for chronic pain, especially compared to other analgesics.
