Accounting for over 18,893 deaths in 2014 alone, opioid overdose has emerged as an endemic in the United States. An unintentional overdose of opioids such as morphine has hitherto been considered the main cause of death but a recent research by Vanderbilt University Medical Centre, Tennessee, United States, has found that even prescribed doses of long-acting opioids, such as methadone and hydromorphone, can elicit cardiovascular disease and respiratory failure and lead to death in patients with chronic noncancer pain.
Globally, opioid drug prescriptions have increased by four times between 1999 and 2014, as reported by Center for Disease Control and Prevention (CDC). Opioids are used for moderate to severe pain that does not ebb away with NSAIDs and other analgesics, such as cancer and chemotherapy pain. Opioids have a tremendous addictive potential; nonetheless the analgesic effect of these drugs surpasses all other pain-killers. As a result, one out of five patients with moderate to severe pain-related diagnosis is put on opioids – a choice that requires careful clinical monitoring, since it can lead to death due to respiratory failure and accidental drug overdose.
Ray, professor of Health Policy at Vanderbilt University School of Medicine, said “We found that the opioid patients had a 64 percent increased risk of death for any reason and a 65 percent increased risk of cardiovascular death.”
Researchers from the Vanderbilt University Medical Centre, Department of Health Policy conducted a retrospective cohort study between 1999 and 2012 on Tennessee Medicaid patients who were prescribed opioids for chronic pain. 75% of these patients received opioid prescription due to complaints about back pain. It is worth noting that participants did not suffer from cancer or other serious ailments but were prescribed opioid for musculoskeletal pain relief only. The findings of this study were also published by The Journal of American Medical Association (JAMA).
22,912 patients received long acting opioids prescription in comparison to the control group that was prescribed low dose cyclic antidepressants or an analgesic anticonvulsant. The group of patients with opioid prescription had a follow up of 176 days and during this time, 185 deaths were reported. On the other hand, the follow up for control group lasted for 128 days and during this time, 87 deaths were reported. The hazard ratio for total mortality showed 69 more deaths per 10,000 patients in narcotic group as compared to the control group. When the cause of death was investigated in long acting opioid group, 47 deaths had causes other than drug overdose and 29 deaths were caused by cardiovascular conditions. According to the researchers, the cardiovascular causes behind deaths may have been caused by adverse effects of the drug on the respiratory system, including obstructive and central sleep apnea.
Opioids are broad spectrum narcotics that interact with opioid receptions in the neural cells of the nervous systems to ease up the pain and related discomfort. Amongst clinically prescribed opioids, oxycodone, hydrocodone, codeine, fentanyl and morphine are common. On the other hand, infamous drug heroin is also classified as an opioid. As the mode of action for heroin and other opioid drugs resembles closely, opioid use quickly transforms into an addiction.
Although the study has reached significant findings, it has some setbacks that could have affected the result accuracy. The records of the deaths and corresponding fatal causes were taken from the information provided on the death certificates. This could have led to misclassification on the death cause in some cases. In addition to this, the study did not address co-morbidity of other non-palliative care-related medical conditions that could have also contributed towards increased risk of opioid drugs.
The researchers of the current study believe that earlier research on the adverse effects of the drug has underestimated the harms of long-acting opioids. Experts recommend that healthcare professionals stall prescribing opioid drugs for as long as possible and consider alternative pain-relieving drugs such as over-the-counter NSAIDs, like ibuprofen or naproxen.
Over-prescription of opioid drugs is a problem across the country. The rate of overdose varies in different states. The states have begun to closely scrutinize drug overdose and the law makers have started taking actions against people involved in this entire process. In this regard, Oregon has adopted a state-wide prescription regulatory mechanism for opioids. A taskforce, proposed by the CDC, has started working on the guidelines.
Dr. Katrina Hedberg, state health officer and epidemiologist said, “The hard work now begins with implementing and communicating about this guideline to clinicians, patients and the public”.
It is common knowledge that people who are prescribed opioid drugs for a condition sometimes have excessive unused quantities of the drug at home or in office, which in turn are used by their friends and family without a prior prescription.
To combat the risks associated with opioid drugs, the government, academia, clinicians and drug regulatory authorities will have to join hands on a national level before it is too late.