Comparative risk of mortality in new users of prescription opioids for noncancer pain: results from the International Pharmacosurveillance Study
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View abstract on PubMed
Summary
This summary is machine-generated.New opioid users for noncancer pain face higher mortality risks with strong opioids like morphine compared to codeine. Higher doses also incrementally increase this risk, highlighting safety concerns in pain management.
Area Of Science
- Pharmacology
- Public Health
- Epidemiology
Background
- Opioids are widely used for noncancer pain globally.
- Evidence on comparative safety of different opioids is limited and conflicting.
- Understanding risks associated with new opioid initiation is crucial for patient safety.
Purpose Of The Study
- To investigate the comparative risk of all-cause mortality in new opioid users for noncancer pain.
- To analyze these risks across three distinct international healthcare systems (UK, US, Canada).
Main Methods
- A multicentre retrospective, population-based cohort study.
- Utilized electronic health records from the UK, US (Boston), and Canada (Montreal).
- Included over 1 million new adult opioid users without cancer, analyzing pain and back pain cohorts separately, using Cox-proportional models.
Main Results
- Morphine use was associated with significantly higher all-cause mortality risk compared to codeine across all three jurisdictions.
- Other opioids including fentanyl, buprenorphine, oxycodone, and combination products also showed increased mortality risk.
- Higher daily doses (≥50 MME/day) were linked to an incremental increase in mortality risk.
Conclusions
- Initiation of strong opioids (morphine, fentanyl, buprenorphine, oxycodone, combination products) for noncancer pain is associated with increased all-cause mortality compared to codeine.
- Higher opioid dosage is a significant risk factor for mortality.
- These findings underscore the need for careful opioid selection and dose management in noncancer pain treatment.
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