Opioid dose associated with mortality in patients with nonmalignant pain

January 01, 0001

Opioid dose associated with mortality in patients with nonmalignant pain

These Canadian authors conducted a population-based nested case-control study of Ontario, Canada, residents aged 15 to 64 years who were eligible for publicly funded prescription drug coverage and had received an opioid from August 1997 through December 2006 for nonmalignant pain. The outcome of interest was opioid-related death, as determined by the investigating coroner. The risk of opioid-related death was compared among patients treated with various daily doses of opioids.

They found: "Among 607,156 people aged 15 to 64 years prescribed an opioid over the study period, we identified 498 eligible patients whose deaths were related to opioids and 1714 matched controls. After extensive multivariable adjustment, we found that an average daily dose of 200 mg or more of morphine (or equivalent), was associated with a nearly 3-fold increase in the risk of opioid-related mortality (OR, 2.88) relative to low daily doses (less than 20 mg of morphine, or equivalent). We found significant but attenuated increases in opioid-related mortality with intermediate doses of opioids (50-99 mg/d of morphine: OR, 1.92; 100-199 mg/d of morphine: OR, 2.04)."

The authors concluded: "Among patients receiving opioids for nonmalignant pain, the daily dose is strongly associated with opioid-related mortality, particularly at doses exceeding thresholds recommended in recent clinical guidelines."

Good reason to avoid prescribing opioids at higher than recommended doses.


For the full abstract, click here.

Arch Intern Med 171(7):686-691, 11 April 2011 © 2011 to the American Medical Association
Opioid Dose and Drug-Related Mortality in Patients With Nonmalignant Pain. Tara Gomes, Muhammad M. Mamdani, Irfan A. Dhalla, J. Michael Paterson, David N. Juurlink. Correspondence to Ms. Gomes: [email protected]

Category: A. General/Nonspecific. Keywords: opiods, non-malignant pain, opioid-related death, nested case- control study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 29 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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