Adverse Opioid-Related Events in Older Breast Cancer Survivors
Posted: Monday, November 23, 2020
Add to the perils of opioid use these statistics: Research results reported in JAMA Network Open found that older women continuing to use prescribed opioids after completing active treatment for breast cancer had a two to three times increased immediate risk of adverse events related to the drugs’ use (not misuse), including falls, fractures, and all-cause hospitalization. Additionally, these survivors had a nearly 15-fold increase in immediate risk of adverse drug events related to opioid misuse.
Andrew W. Roberts, PharmD, PhD, of the University of Kansas Medical Center, Kansas City, and colleagues retrospectively examined Surveillance, Epidemiology, and End Results–Medicare data of 38,310 women in the year after their breast cancer treatment. Those still using prescription opioids in that time frame created a population for which “little is known about the rates and risk factors for comprehensive opioid-related harms,” they noted. The patients, between the ages of 66 and 90 (mean, 74.3 years), were initially diagnosed with stage 0, I, II, or III breast cancer between 2008 and 2015.
Those who had opioid exposure, especially high-dose opioid exposure, on any given day “had significantly higher immediate adjusted risk of myriad serious adverse drug events compared with their risk on days without opioid exposure,” wrote Dr. Roberts and co-investigators. Two to three times higher, notably, were “the risks of gastrointestinal events, infection, falls and fractures, and cardiovascular events.”
“Clinicians [need] to recognize that opioid-related risks in this population extend beyond misuse, overdose, and opioid use disorder,” the authors stated. Although misuse events like overdose remain a concerning possibility, the serious adverse drug events related to use versus misuse were more than 20-fold more common. The researchers calculated that, per 1,000 person-days, 0.010 adverse drug events related to substance misuse, 0.237 other adverse drug events associated with opioid use, and 0.675 all-cause hospitalizations each occurred. Compared with no opioid use, opioid use was significantly associated with these three outcomes (P < .001 for all).
Disclosure: The study authors’ disclosure information can be found at jamanetwork.com.
