Opioid Use in Older Adults with COPD Increases Risk of Death

Chronic obstructive pulmonary disease (COPD) patients who start taking opioids have a 5 times higher risk of respiratory-related death compared with non-opioid users.

COPD affects about 4 to 10% of the Canadian population, and has a 5-year mortality rate from 40 to 70%, depending on the severity of the disease. In a study published in the European Respiratory Journal, researchers raised concerns on the safety of new opioid use among older COPD patients.

For the study, researchers examined records from 130,000 COPD adults in Ontario 66-years-old and up. They used multiple provincial health care administrative databases at the Institute for Clinical Evaluative Sciences.

“This is a population that has a chronic lung disease, with symptoms that can sometimes be challenging to manage,” said lead study author Nicholas Vozoris. “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.”

The results of the study showed that between April 2007 and March 2012, 68% of older adults with COPD who lived in the community were given a new opioid prescription.

“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 opioid use, but also increased risk, of visits to emergency rooms, hospitalizations, and needing antibiotics or steroid pills.”

Although it’s believed that prescribing less potent or lower dosages of opioids may help lower the risks of adverse events in this population, the authors said they still found a significant increased risk of respiratory-related complications and death in new opioid users, regardless of dose.

“This is an important finding because it has been previously thought that lower opioid doses might be safe for COPD patients,” Vozoris said.

Current guidelines recommend that opioids be used for COPD patients to manage difficult-to-control respiratory symptoms that can frequently compromise a patient’s quality-of-life. But, findings from the study do not support the use of opioids to help manage chronic pain.

“Sometimes patients are looking for a quick fix for chronic pain or breathing issues and physicians may believe opioids can offer them some relief,” Vozoris said. “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.”