Are Opioids Safe for COPD Patients?

According to new research, incident opioid use was linked to a greater risk of adverse respiratory outcomes, including respiratory-related mortality, among older patients with chronic obstructive pulmonary disease (COPD).

In a retrospective population-based cohort study, investigators evaluated data from roughly 131,000 COPD patients, aged 66 years and older, with COPD, who were treated during a 5-year period.

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Overall, incident opioid use was associated with "significantly increased" emergency room visits for COPD or pneumonia, COPD or pneumonia-related mortality, and all-cause mortality, but was associated with significantly decreased outpatient exacerbations, according to the authors. The use of more potent opioid-only agents was also connected to greatly increased outpatient exacerbations, emergency room visits, and hospitalizations for COPD or pneumonia, and COPD or pneumonia-related and all-cause mortality.

"Given that we have shown that new opioid use among older adults with COPD is associated with increased risk of several serious negative respiratory outcomes, I hope that physicians incorporate this information in their decision-making regarding prescribing this drug class in COPD, and ultimately demonstrate more caution when prescribing," said Nicholas T. Vozoris, MHSc, MD, FRCPC, an associate scientist at St. Michael's Hospital's Li Ka Shing Knowledge Institute in Toronto, and lead author of the study.

The study also demonstrates that "there does not appear to be a 'safe' opioid level that can be prescribed to older adults with COPD," said Dr Vozoris, noting that adverse "respiratory outcomes were observed even with lower dose and shorter-acting opioids."

The findings do not apply to COPD patients receiving palliative care, he added, "as we intentionally excluded this subgroup from the study, as it is a special circumstance where opioids may very well need to be prescribed and where possible risks of drug use would be acceptable."

The purpose of this study "was to examine the broad use of opioids in the general COPD population," Dr Vozoris said, "and we have shown that opioid use is remarkably high and associated with clinically-important adverse respiratory outcomes."

—Mark McGraw


Vozoris NT, Wang X, Fischer HD et al. Incident opioid drug use and adverse respiratory outcomes among older adults with COPD [published online July 2016]. Eur Respir J. doi:10.1183/13993003.01967-2015.