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Opioid Health Risks for Elders Found in Comparative Analysis

Kathleen Blanchard's picture

Researchers conducted two separate studies highlighting the potential dangers of opioid use among elders. In one study, the drugs were compared to coxibs and NSAID’s. In a second study, an analysis, 5 different drugs were compared for safety.

NSAID’s, non-steroidal anti-inflammatory drugs and coxibs are shunned by prescribers because of the potential for cardiovascular events, but the study authors say,”… there is little comparable information about the third major analgesic group, opioids." They note, "In the United States, one in five adults received a prescription for an analgesic in 2006, accounting for 230 million prescription purchases; however, the comparative safety of these drugs is unclear.”

In the first analysis, Daniel H. Solomon, M.D., M.P.H., and colleagues at Brigham and Women's Hospital, Boston compared the safety of non-steroidal anti-inflammatory drugs to opioid use among 12,840 Medicare beneficiaries between 1999 and 2005.

Using a claims database, the researchers looked at the incidence of stroke, heart attack, heart failure, gastrointestinal bleeding, kidney injury, liver toxicity, falls and fractures. The researchers found there were more adverse health events in most of the categories from opioid use, compared to coxibs or NSAID’s.

In the second study, only different types of opioids were compared for safety given to elders between 1996 and 2005. The researchers compared the number of unsafe events at 30 and 180 days among 6,275 patients, comparing codeine, hydrocodone, oxycodone, propoxyphene and tramadol.

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The analysis showed similar rates of gastrointestinal events for all of the opioids studied, beginning 30 days after start of therapy. Cardiovascular events were equal for all of the drugs. After 180 days, the chances of cardiovascular events increased with codeine use. Compared to hydrocodone, the risk of fracture was 79 percent lower for those taking tramadol and 46 percent lower when propoxyphene was used for pain management.

Compared to hydrocodone, oxycodone was 2.4 times likely to increase the risk of dying from any cause, and codeine was twice as likely to raise the chances of death.

Fractures occurred at a rate of 101 per 1,000 annually for opioid users, compared to 19 per 1,000 per year for elders using coxibs.

The findings are observational say the authors, but should "prompt further study". The findings raise concerns about the health risks to elders who take opioids for chronic pain. The study revealed more adverse events from opioids than found from coxibs and non-steroidal anti-inflammatory drugs.

Arch Intern Med. 2010;170[22]:1968-1978, 1979-1986, 2035-2036