A Canadian study published Thursday shows male patients more than twice as likely to die from opioid use as are women patients. The study also found that 1 in 10 people who start on opipids for non-cancer related pain relief turn into chronic users. The study co-author, scientist Tara Gomes, said results have raised red flags.
“It’s a little surprising and quite concerning that such a large number of people who start these drugs are continuing them for such a long time,” said Gomes, from the Institute for Clinical Evaluative Sciences in Toronto. “It really suggests that patients and doctors need to reconsider whether or not there should be such broad use of long-term opioid therapy, particularly when often times patients aren’t really seeing a lot of benefits.”
Published in the online journal PLOS One and titled Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy, the study looked at the records of men and women prescribed an opioid for pain relief between 1997 and 2010, and at other times. The more commonly prescribed opioids were codeine, fentanyl, hydrocodone and oxycodone.
Data on opioid usage
They examined the healthcare records of 32,499 people between the ages of 15 and 64 prescribed an opioid for non-cancerous pain relief between 1997 and 2010; all patients were from the Canadian province of Ontario and all were followed from the beginning of their prescription either until they ended it, until the study years ended or until their death. They also looked at data from 285,520 patients prescribed opioids for any duration of time.
“Patients were followed from their first opioid prescription until discontinuation of therapy, death from any cause or the end of the study period,” the study reads, referring to the 32,499 patients. “Among patients receiving chronic opioid therapy, 589 (1.8%) escalated to high dose therapy and 59 (0.2%) died of opioid-related causes while on treatment.
“After multivariable adjustment, men were more likely than women to escalate to high-dose opioid therapy…and twice as likely to die of opioid-related causes…These associations were maintained in a secondary analysis of 285,520 individuals receiving any opioid regardless of the duration of therapy.”
Gomes said they do not know why men are more than twice as likely to die from opioid use after first being prescribed it but has some thoughts on the matter. She said doctors may prescribe higher doses to men and that men may not tolerate pain as well as women and so request a dose increase. Finally, she noted that men are more likely to overuse alcohol and the combination of opioids and booze is a dangerous one.
The study did not have data on any patients who added to their prescriptions by illegally obtaining extra opioids. One of the study authors is receiving an honoria from a pharmaceutical company.
In 2010 the Canadian Medical Association published an opioid prescription guideline for family physicians called Opioids for chronic noncancer pain: a new Canadian practice guideline. It was an attempt to lower the amount of patients chronically useing opioids and prevent opioid deaths.
It is unclear if the guidelines are being followed by doctors, or if they’ve had a positive effect.