Different Opioids Linked to Different Risks of Events

Subjects were Medicare beneficiaries prescribed five common opioids for nonmalignant pain

WEDNESDAY, Dec. 15 (HealthDay News) -- The risks of adverse events among older adults using opioid analgesics for nonmalignant pain varies by agent, according to research published in the Dec. 13/27 issue of the Archives of Internal Medicine.

Daniel H. Solomon, M.D., M.P.H., of Brigham and Women's Hospital in Boston, and colleagues analyzed data from 6,275 matched Medicare beneficiaries in each of five opioid groups who began opioid therapy for nonmalignant pain. Subjects were prescribed hydrocodone bitartrate, codeine phosphate, oxycodone hydrochloride, propoxyphene hydrochloride, and tramadol hydrochloride.

The researchers found that the groups had similar risk of cardiovascular events 30 days after starting opioid treatment, but the risk was higher with codeine after 180 days (rate ratio [RR], 1.62). After 30 days of exposure, the risk of fractures was lower with tramadol and propoxyphene compared to hydrocodone (RRs, 0.21 and 0.54, respectively). The risk of gastrointestinal safety events was similar across groups. Oxycodone and codeine users had more all-cause mortality after 30 days compared to hydrocodone users (RRs, 2.43 and 2.05, respectively).

"In summary, we explored possible differences in risk between opioids commonly used for nonmalignant pain and found that the risk varied by agent across many of the adverse events examined," the authors conclude. "The risks were substantial and translated into numbers needed to treat that would be considered clinically significant. Our findings regarding cardiovascular risk were surprising and require validation in other data sets."

A co-author disclosed unpaid relationships with Pfizer.

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