New opioid use in adults with chronic obstructive pulmonary disease associated with increased risk of death

Older adults with chronic obstructive pulmonary disease who start using opioids have a more than two-fold higher risk of dying from a respiratory-related complication compared to non-opioid users, researchers from St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES) have found.

When researchers looked specifically at more potent opioids, such as morphine, they found the risk for respiratory-related death was five times higher for new opioid users compared to non-opioid users.

The study, published today in the European Respiratory Journal, raises safety concerns about new opioid use among adults with chronic obstructive pulmonary disease, or COPD, a progressive lung disease that causes breathing difficulty, said Dr. Nicholas Vozoris, a respirologist at St. Michael’s and lead author of the study.

COPD affects approximately four per cent of the Canadian population, with the five-year mortality typically ranging from 40 to 70 per cent, depending on the severity. The two-year mortality rate for people with severe COPD is about 50 per cent.

The researchers looked at the records of more than 130,000 adults in Ontario age 66 and older with COPD, using multiple provincial healthcare administrative databases at ICES.

“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 more sensitive to narcotics,” said Dr.  Vozoris. “Our new findings confirm there are not only increased risks for respiratory-related death associated with new opioid use, but also increased risk of complications and visits to emergency rooms.”

Dr. Vozoris found that 68 per cent of older adults with COPD living in the community were given a new opioid prescription between April 2007 and March 2012.  Opioids, such as codeine, oxycodone and morphine are prescribed frequently among older adults with COPD to treat chronic muscle and bone pain, coughs and shortness of breath, as well as insomnia.

“This is a population that has a chronic lung disease, with hard-to-manage symptoms and this class of drugs can offer some relief,” said Dr. Vozoris. “However, the evidence suggests that opioids can adversely affect breathing and lung health in people who already have chronically compromised lungs.”

To lower the risks of adverse events in this population, the recommendation would usually be to prescribe less potent opioids, or a lower dosage. However, Dr. Vozoris and his team still found a significantly increased risk of respiratory-related complications and death in new opioid users, regardless of dose. “This is an important finding because current research and practice has thought lower opioid doses are safe for COPD patients or those with respiratory issues,” said Dr. Vozoris.

Dr. Vozoris hopes that clinicians take these findings into consideration when prescribing opioids to COPD patients. Current guidelines recommend their use to manage complex symptoms that can often compromise a patient’s quality of life.

“Sometimes patients are looking for a quick fix for chronic pain or breathing issues and physicians may believe opioids can offer them some relief,” said Dr. Vozoris. “The trade-off becomes explaining that there are risks to patients and making sure they understand that alleviating their symptoms could come at a higher cost to their health.”

This research was funded by a grant from the Lung Association-Canadian Thoracic Society National Grant Review/Grant-in-Aid.

About St. Michael’s Hospital – St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

For more information, please contact:

• Kendra Stephenson 
• Communications Adviser – Media
• St. Michael's Hospital
• 416-864-6060 ext.7178
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• Kathleen Sandusky
• Media Advisor, ICES
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• (o) 416-480-4780 or (c) 416-434-7763