COPD patients are often prescribed opioids such as codeine, oxycodone and morphine to provide relief from common symptoms such as muscoskeletal pain, insomnia and respiratory issues. However it has been shown by researchers in Toronto, Canada that opioids can induce additional respiratory side effects and that new opioid users have 5 times a greater risk of death compared to non-opioid users. These results raise serious safety concerns about the use of opioids for older adults with COPD.
“This is a population that has a chronic lung disease, with symptoms that can sometimes be challenging to manage,” said Dr. Nicholas Vozoris, lead author of the study. “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.”
Previous studies reported that opioids were safe for patients with advanced COPD but the results were not reliable due to study limitations.
In this new study over 130,000 patient records were examined from multiple healthcare databases to try to ensure the results were more generally applicable and reliable.
“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,” Vozoris said. “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.”
The team found that those who used opioids had an increased risk of 14% or ending up in the emergency department and nearly 3 times the risk of COPD or pneumonia-related mortality. They even have an overall mortality risk of 76% compared to non-opioid users. Opioids were however found to decrease the risk of respiratory exacerbations by 12%.
The higher risks were found in patients using stronger or higher dosage opioids however many risks were unaffected by dosage if you were a new user.
Opioids can impact COPD patients in several ways such as respiratory depression, reduced mucous clearance from cough suppression, and immunosuppressive effect.
To lower the risks of adverse events doctors may 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.
“Sometimes patients are looking for a quick fix for chronic pain or breathing issues and physicians may believe opioids can offer them some relief,” he added. “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.”
An individual multi-disciplinary approach is better as a treatment plan rather than just prescribing opioids. Making use of pulmonary rehabilitation, supplemental oxygen therapy, exercise and lifestyle changes in conjunction with medication is best way forward for COPD patients.