Winfried Häuser and investigators discussed about the need of consideration of suitable risk for all-cause mortality due to opioid usage in patients with chronic non-cancer pain (CNCP) on long-term opioid therapy (LTOT) in their new database in BMC Medicine journal.

This study was performed with an aim to examine the all-cause mortality for CNCP linked with all recognized opioids compared to non-opioid analgesic therapy (like NSAIDs, anticonvulsants, antidepressants, dipyrone). An anonymized healthcare claims database-the InGef (Institute for Applied Health Research Berlin) including 4,711,668 insured persons covered by 61 German statutory health insurances between the year 2013 and 2017 was considered. The death certificates were used to ascertain the all-cause mortality. The adjusted hazard ratios (HRs) and risk differences (RD) in concerning mortality between patients with LTOT and controls were deliberated.

Out of total participants under consideration, 55% of them were females. For patients using LTOT, 554 deaths during 10,435 person-years, while, for the controls, 340 deaths during 11,342 person-years were observed. The HR for all-cause mortality was 1.59 with a RD of 148 excess deaths per 10,000 person-years. High rate of mortality for LTOT was limited to out-of-hospital mortalities: LTOT patients had 288 deaths during 10,435 person-years and 110 deaths during 11,342 person-years in control group. The table below shows the total number of deaths in both groups.

A higher incidence of heart failure and increased use of psycholeptic, anti-thrombotic and antiplatelet agents was perceived from opioid group.