The case against opioid painkillers has just got stronger

People who use certain prescription painkillers increase their risk of heart-related deaths, according to a report published in the Journal of the American Medical Association.

A study of 45,000 patients found that those using opioids were 64 per cent more likely to die within six months of starting a course of medication, compared to those taking other prescription painkillers.

The researchers say that for every 145 patients taking an opioid drug, there is one excess death that would not have occurred on other types of painkiller.

It is also easier to overdose on opioids; accidental overdoses account for about 18 per cent of the deaths among opioid users, compared with eight per cent of other patients.

Opioids available on prescription in the UK include codeine, tramadol, methadone, diamorphine, fentanyl and oxycodone.

Instant analysis
The potential risks of opiates are well known but are often confined to the problem of accidental overdoses. This large study involving over 45,000 patients between 1999 and 2012 compared the death rate of people with non-cancer chronic pain who were taking either long-acting opioid painkillers or alternative non-opioid analgesia.

The salient finding is that the long-acting opioid group was significantly at a higher risk of death compared with other treatments such as anticonvulsants or tricyclic antidepressants used for pain relief.

One of the reasons for this appears to be an increased risk of heart-related deaths, and is further evidence that great care should be taken when these drugs are being prescribed for chronic pain, especially in those with a history of heart and lung problems.

Although this is not groundbreaking research, it does add further weight to the difficulties that clinicians have when balancing the risk of strong painkillers against their benefits.
Research score: 4/5

  • Robert Jones

    No, it isn’t groundbreaking research. It isn’t even surprising research. Some of us take opioids because life would be intolerable without pain relief – inadequate though it is – and because, in order: tricyclic antidepressants don’t work; anti-convulsants can cause blood disorders – and don’t work for most of us; non-steroidal anti-inflammatories, including aspirin, Naproxen, Voltarol/diclofenac et al do work, but at the cost of causing potentially fatal internal bleeding; and paracetamol is good for headache and just about nothing else. You don’t take these things because you just LOVE them, and prescribing in this country is better regulated than in the USA, where the real difficulty with Fentanyl in particular lies.