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Opioid use for chronic pain increases mortality risk over other pain meds, study finds

Patients with chronic pain who are being treated with long-acting opioids have a much higher risk of death than those being treated with other medications, a new study shows. The study results also underscore that death risks associated with opioids go beyond accidental overdose.

Researchers led by Wayne A. Ray, PhD at the Vanderbilt University School of Medicine found that mortality rates were 64 per cent higher in patients taking long-acting opioids compared to those being treated with analgesic anticonvulsants or low-dose cyclic antidepressants. In addition to this increased risk of dying from any cause, the researchers found that patients taking opioids had a 65 per cent higher risk of dying from cardiovascular causes.

Risk was highest in the first 30 days after starting opioid medications. Compared to patients taking the other medications, those taking opioids had more than four times the risk of dying in the first month of treatment.

The researchers note that unintentional overdoses accounted for less than one-third of the excess deaths in the opioid group. About one-third were cardiovascular deaths. 

The study looked at Medicaid patients in Tennessee who started medication for chronic, non-cancer pain between 1999 and 2012. The most common reasons for pain treatment were back pain and musculoskeletal pain. The study excluded patients who had cancer or a life-threatening diagnosis, or who were older than 75. Average age of study participants was 48, and 60 per cent were women.

The researchers matched 22,912 patients who were prescribed opioids with the same number of patients taking anticonvulsants or cyclic antidepressants. Long acting opioids include sustained-release morphine, controlled release oxycodone, fentanyl patches and methadone.

The study findings highlight the dangers of opioid pain drugs beyond accidental overdose, and support recent recommendations from the Centers for Disease Control to avoid treating chronic pain with long-acting opioids whenever possible.

The study was published in JAMA on June 14, 2016.



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  • A publication of:
  • Women's College Hospital