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Infection risk among long-acting opioid users varies by opioid type
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Results of a retrospective study of more than 60,000 patients initiating long-acting opioids found that their risk for infection varied by opioid type. Patients using nonimmunosuppressive opioids had a 22% lower rate of serious infections than immunosuppressive opioid users, researchers reported.
“The opioid epidemic in the United States was recently declared a public health emergency,” Andrew D. Wiese, PhD, MPH, postdoctoral research fellow at Vanderbilt University, and colleagues wrote in Clinical Infectious Diseases. “Opioid use is associated with increased morbidity and mortality due to overdose, adverse respiratory outcomes, cardiovascular events, as well as serious infections.”
According to Wiese and colleagues, prior research indicates that certain opioids — including fentanyl, methadone and morphine — can disrupt immune responses and increase a person’s susceptibility to infections, but similar effects have not been documented with other opioids.
“Existing evidence from randomized controlled trials is insufficient to elucidate the relevance of this opioid-induced immunosuppression on clinical outcomes due to limited sample sizes and incomplete reporting of infections,” they wrote. “Thus, whether the risk of serious infection varies by specific opioid formulation remains unclear.”
To compare the risk for serious infection among patients initiating the use of different long-acting opioids with and without previously reported immunosuppressive properties, Wiese and colleagues conducted a retrospective cohort study of Tennessee Medicaid enrollees aged 18 years or older who initiated long-acting opioids between January 1995 and September 2015. They calculated adjusted incidence rate ratios and CIs to compare the risk for infection among patients using long-acting opioids with known immunosuppressive properties, including fentanyl, methadone and morphine, with that of patients using long-acting opioids without immunosuppressive properties, such as oxycodone, oxymorphone and tramadol.
Among the 61,240 patients initiating opioids with immunosuppressive properties and 22,811 patients initiating opioids without immunosuppressive properties, Wiese and colleagues reported identifying 1,906 serious infections. Infections identified included pneumonia, bacteremia/sepsis, pyelonephritis, meningitis/encephalitis, osteomyelitis/septic arthritis, endocarditis and cellulitis.
According to the researchers, most patients (45.2%) initiated the use of long-acting morphine, followed by fentanyl (20.9%), oxycodone (19.7%), methadone (6.7%), oxymorphone (4.6%) and tramadol (2.9%).
According to the study, nonimmunosuppressive opioid users had a lower rate of infections than immunosuppressive opioid users (adjusted incidence rate ratio = 0.78; 95% CI, 0.66-0.91). Among users of individual opioids, oxycodone users had a lower rate of infection than morphine users, and there was no significant difference in the infection risk between users of other opioids and morphine, the study revealed.
“Our findings demonstrate that among patients initiating long-acting opioid analgesic use, patients using opioids without previously reported immunosuppressive properties had a lower risk of hospitalization for serious infections compared to immunosuppressive opioids,” the authors concluded. “The risk of serious infections among long-acting opioid users varies by opioid type. Providers should carefully consider the risk of serious infections when making pain management decisions.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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