Opioids are often prescribed for older adults in the late or terminal stages of chronic obstructive pulmonary disease (COPD).
These drugs provide relief not only from COPD-related chronic muscle and bone pain, but also from other symptoms like persistent cough, shortness of breath, and insomnia.
But like all medications, the benefits of opioids need to be carefully weighed against the side effects.
A new study suggests that older adults with COPD need to be better informed about the potential downside of these drugs.
That includes a greater risk of respiratory-related complications and death, compared to non-opioid users.
“Sometimes patients are looking for a quick fix for chronic pain or breathing issues and physicians may believe opioids can offer them some relief,” Dr. Nicholas Vozoris, a respirologist at St. Michael's Hospital in Toronto, and lead author of the study, said in a press release. “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.”
Opioids increase risk of death
COPD is a progressive lung disease that makes it hard to empty air out of the lungs.
Emphysema and chronic bronchitis are two types of the condition.
About 15 million people in the United States have been diagnosed with COPD. In 2001, COPD and other types of chronic lower respiratory disease were listed as the third leading cause of death in the United States.
COPD is a lifelong condition. Treatment focuses on relieving symptoms, limiting the factors that make the symptoms worse, and making it easier for a person to exercise.
Treatments include pulmonary rehabilitation, quitting smoking, and the use of medications.
The new study, published today in the European Respiratory Journal, raises concerns about one type of medication used in older adults with COPD — opioids such as oxycodone and morphine.
Researchers looked at the medical records of more than 130,000 people in Ontario aged 66 and older with COPD. The data came from multiple healthcare databases.
The researchers found that 68 percent of older adults with COPD were given a new opioid prescription between April 2007 and March 2012.
Older adults who were using opioids for the first time during the past year had an increased risk of respiratory-related death, visits to the emergency room or hospitalization, and needing steroid pills or antibiotics.
Their risk of dying from COPD or pneumonia within 30 days after starting opioids was more than two times higher than in non-opioid users. Opioid users’ risk of dying from any cause was also increased.
The higher risk held even when the researchers took into account the presence of other health conditions, like heart disease, cancer, and chronic muscle and bone diseases.
“We even performed a subgroup analysis, where we removed individuals with background cancer and we still found increased risk of negative COPD outcomes among new versus non-opioid drug users,” said Vozoris in a follow-up email to Healthline. “[And we found an] increased risk of negative outcomes among healthier or less severe COPD subgroups.”
Risks at all opioid doses
Managing the symptoms of COPD can be difficult.
While opioids can provide some relief, these medications can make it more difficult to breathe for people whose lungs are already compromised.
A 2014 study found that the use of higher doses of opioids in people with COPD was associated with an increased risk of death from any cause. However, this study did not see an increased risk from lower doses.
The new study, though, suggests that using a lower dose or less potent opioid may not be enough to eliminate these risks.
“We found increased risk of adverse respiratory outcomes among new opioid users, regardless of drug dose and drug half-life,” said Vozoris. “So our study results do not support a particular drug dose or drug half-life being safe for patients with COPD.”
The authors write that several guidelines, such as those of the American College of Chest Physicians, support “careful opioid use in the setting of advanced COPD.”
The Global Initiative for Chronic Obstructive Lung Disease guidelines, however, advises that morphine can have severe effects, and its use in COPD may only be appropriate for a few patients.
As Dr. James Downar, a critical care and palliative care physician at University Health Network in Toronto, who was not involved in the study, pointed out in an interview with The Globe and Mail, the study does not prove that the opioids caused the respiratory-related complications and death in older COPD patients.
Patients taking opioids may have been sicker, which led to those poor outcomes.
The results of this study, however, suggest that older adults with COPD may need to carefully weigh the benefits of opioids against the potentially serious risks.
“I hope our study results serve as a prompt for the medical community to reevaluate how we use opioids in COPD,” said Vozoris, “and also foster a reevaluation and reflection of some of the current COPD guidelines or consensus statement thinking.”