Increased Mortality from Long-Acting Opioids for Non-Cancer Pain

Long-acting opioids for noncancer pain associated with increased risk of
death from causes other than overdose

Clinical Question:
Do long-acting opioids increase the risk of death from causes other than overdose in
adults with noncancer chronic pain?

Bottom Line:
The use of long-acting opioids for chronic noncancer pain as compared with anticonvulsants or cyclic antidepressants is associated with a significantly increased risk of premature mortality–not only from unintentional overdose, but also from
other causes. Although it is possible for observational trials like this to
be confounded by unadjusted treatment associations, this is likely to be
the best evidence we’ll have on this question; it would be difficult to
perform a more rigorous long-term randomized controlled trial. A recent
systematic review (Chaparro LE, et al. Spine 2014;39:556-63) also found
minimal evidence for long-term improvement in function from opioid therapy.
(LOE = 3b)

Reference:
Ray WA, Chung CP, Murray KT, Hall K, Stein CM.
Prescription of long-acting opioids and mortality in patients with chronic

noncancer pain. JAMA 2016;315(22):2415-2423.
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