In the Journals

Opioid use raises risk for serious infections

Use of prescription opioids significantly increases the risk for serious invasive pneumococcal infections, according to research published in Annals of Internal Medicine.

“As opioid analgesic use has increased in the United States, the safety of prescription opioids has come under further scrutiny... Although concern has been expressed regarding a potential excess of infections observed among prescription opioid users, few studies have attempted to quantify the risk for infection in this group,” Andrew D. Wiese, PhD, from Vanderbilt University Medical Center, and colleagues wrote.

Wiese and colleagues conducted a nested case-control study to determine the clinical effects of prescription opioid use on the risk for invasive pneumococcal disease. The researchers identified 1,233 case patients aged 5 years and older with invasive pneumococcal disease who were enrolled in Tennessee’s Medicaid program, TennCare. These patients were matched by diagnosis date, age and county of residence to 24,399 control participants.

The researchers measured opioid use using data on pharmacy prescription fills and compared current use among the case and control groups while accounting for risk factors of invasive pneumococcal disease.

Use of prescription opioids significantly increases the risk for serious invasive pneumococcal infections.
Photo credit: Shutterstock

The results showed that the odds of being a current opioid user was higher among participants in the case group than the control group (adjusted OR = 1.62; 95% CI, 1.36-1.92).

The association between opioid use and risk of laboratory-confirmed invasive pneumococcal diseases was strongest for opioids that had long-acting formulations (aOR = 1.87; 95% CI, 1.24 -2.82), were classified as high potency (aOR = 1.72; 95% CI, 1.32-2.25) or used at high dosages, such as 50 to 90 morphine milligram equivalents per day (aOR = 1.71; 95% CI, 1.22-2.39) and 90 or more morphine milligram equivalents per day (aOR = 1.75; 95% CI, 1.33-2.29).

These results remained after accounting for invasive pneumococcal disease risk and analyzing pneumonia and nonpneumonia invasive pneumococcal disease separately.

“Our study findings complement the experimental evidence from animal models and initial studies in humans and indicate that prescription opioid use is an independent, novel risk factor for [invasive pneumococcal disease],” Wiese and colleagues concluded. “These findings should be considered when developing [invasive pneumococcal disease] prevention recommendations, including vaccination.”

“Furthermore, this previously unrecognized association between opioid use and [invasive pneumococcal disease] highlights the need for judicious use of opioid analgesics that considers both the benefits and risks of these medications,” they added. “Because the strongest associations were observed for opioids with certain characteristics, these findings should be considered when selecting opioid analgesics for pain management.”

In an accompanying editorial, Sascha Dublin, MD, PhD, and Michael Von Korff, ScD, both from Kaiser Permanente Washington Health Research Institute, wrote that the findings by Wiese and colleagues offer “cautionary evidence” that prescription opioid use increases infection risk and highlights the need for measures to protect patients even though there are remaining uncertainties.

“Opioid prescribing should be consistently cautious and closely monitored among all patients, especially those at increased risk for infections, who may be particularly susceptible to harm... Before prescribing an opioid, the clinician should carefully consider all reasonable alternative approaches to pain relief. It now seems that decision making also should take into account the risk for serious infections,” they wrote. – by Alaina Tedesco

Disclosure: Wiese reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures. Dublin reports receiving support from Jazz Pharmaceuticals. Von Korff reports receiving grants from Pfizer Inc. and Campbell Alliance.

Use of prescription opioids significantly increases the risk for serious invasive pneumococcal infections, according to research published in Annals of Internal Medicine.

“As opioid analgesic use has increased in the United States, the safety of prescription opioids has come under further scrutiny... Although concern has been expressed regarding a potential excess of infections observed among prescription opioid users, few studies have attempted to quantify the risk for infection in this group,” Andrew D. Wiese, PhD, from Vanderbilt University Medical Center, and colleagues wrote.

Wiese and colleagues conducted a nested case-control study to determine the clinical effects of prescription opioid use on the risk for invasive pneumococcal disease. The researchers identified 1,233 case patients aged 5 years and older with invasive pneumococcal disease who were enrolled in Tennessee’s Medicaid program, TennCare. These patients were matched by diagnosis date, age and county of residence to 24,399 control participants.

The researchers measured opioid use using data on pharmacy prescription fills and compared current use among the case and control groups while accounting for risk factors of invasive pneumococcal disease.

Use of prescription opioids significantly increases the risk for serious invasive pneumococcal infections.
Photo credit: Shutterstock

The results showed that the odds of being a current opioid user was higher among participants in the case group than the control group (adjusted OR = 1.62; 95% CI, 1.36-1.92).

The association between opioid use and risk of laboratory-confirmed invasive pneumococcal diseases was strongest for opioids that had long-acting formulations (aOR = 1.87; 95% CI, 1.24 -2.82), were classified as high potency (aOR = 1.72; 95% CI, 1.32-2.25) or used at high dosages, such as 50 to 90 morphine milligram equivalents per day (aOR = 1.71; 95% CI, 1.22-2.39) and 90 or more morphine milligram equivalents per day (aOR = 1.75; 95% CI, 1.33-2.29).

These results remained after accounting for invasive pneumococcal disease risk and analyzing pneumonia and nonpneumonia invasive pneumococcal disease separately.

“Our study findings complement the experimental evidence from animal models and initial studies in humans and indicate that prescription opioid use is an independent, novel risk factor for [invasive pneumococcal disease],” Wiese and colleagues concluded. “These findings should be considered when developing [invasive pneumococcal disease] prevention recommendations, including vaccination.”

“Furthermore, this previously unrecognized association between opioid use and [invasive pneumococcal disease] highlights the need for judicious use of opioid analgesics that considers both the benefits and risks of these medications,” they added. “Because the strongest associations were observed for opioids with certain characteristics, these findings should be considered when selecting opioid analgesics for pain management.”

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In an accompanying editorial, Sascha Dublin, MD, PhD, and Michael Von Korff, ScD, both from Kaiser Permanente Washington Health Research Institute, wrote that the findings by Wiese and colleagues offer “cautionary evidence” that prescription opioid use increases infection risk and highlights the need for measures to protect patients even though there are remaining uncertainties.

“Opioid prescribing should be consistently cautious and closely monitored among all patients, especially those at increased risk for infections, who may be particularly susceptible to harm... Before prescribing an opioid, the clinician should carefully consider all reasonable alternative approaches to pain relief. It now seems that decision making also should take into account the risk for serious infections,” they wrote. – by Alaina Tedesco

Disclosure: Wiese reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures. Dublin reports receiving support from Jazz Pharmaceuticals. Von Korff reports receiving grants from Pfizer Inc. and Campbell Alliance.

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