The comparative safety of opioids in older adults

January 01, 0001

The comparative safety of opioids in older adults

Severe nonmalignant pain affects a large proportion of older adults. These US authors devised a propensity-matched cohort analysis that used health care utilization data collected from January 1, 1996, through December 31, 2005 to assess comparative safety of opioids. Study participants were Medicare beneficiaries from 2 US states who were new initiators of opioid therapy for nonmalignant pain, including codeine phosphate, hydrocodone bitartrate, oxycodone hydrochloride, propoxyphene hydrochloride, and tramadol hydrochloride; none had a cancer diagnosis, and none were using hospice or nursing home care.

They found: "We matched 6275 subjects in each of the 5 opioid groups. The groups were well matched on baseline characteristics. The risk of cardiovascular events was similar across opioid groups 30 days after the start of opioid therapy, but it was elevated for codeine (RR, 1.62) after 180 days. Compared with hydrocodone, after 30 days of opioid exposure the risk of fracture was significantly reduced for tramadol (RR, 0.21) and propoxyphene (0.54) users. The risk of gastrointestinal safety events did not differ across opioid groups. All-cause mortality was elevated after 30 days for oxycodone (RR, 2.43) and codeine (2.05) users compared with hydrocodone users."

The authors concluded: "The rates of safety events among older adults using opioids for nonmalignant pain vary significantly by agent. Causal inference requires experimental designs, but these results should prompt caution and further study."

Most striking is the increase in all-cause mortality associated with oxycodone and codeine.

For the full abstract, click here.

Arch Intern Med 170(22):1979-1986, 13/27 December 2010 © 2010 to the American Medical Association
The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults. Daniel H. Solomon, Jeremy A. Rassen, Robert J. Glynn, et al. Correspondence to Dr. Solomon: [email protected]

Category: A. General/Unspecified. Keywords: opioids, older adults, hydrocodone, oxycodone, codeine, tramadol, propoxyphene, case control study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 11 January 2011

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