How Dangerous are Opioid Painkillers?

While there is no question that opioid dependence is becoming a major problem, new research is also showing a rise in opioid-related deaths as well.   Along with prescription drug abuse, opioids being sold as street drugs, and patients who doctor-shop to feed their drug habit,  physicians have long warned that young and middle-aged patients are especially prone to premature death due to misuse of opioid painkillers.   That includes morphine, codeine, oxycodone, hydrocordone, and an array of new painkillers that are coming on the market.  

In North America, most opioid-related deaths occur in people 55 years of age or youger.   Much of this can be linked to recreational use of drugs, especially in younger adults and adolescents, with one in seven high-school or university students reporting non-medical uses for opioids.   The premature mortality reported in many jurisdictions may be costing more than $18 B in lost earnings in the United States alone.  

Part of the problem with identifying the prevalence of opioid-related deaths is that many go unreported depending on the medical information available at the time of death.   To gain a clearer picture of how many deaths can be linked to opioid use, a new research study recently published in the journal Addiction looked at opioid deaths over a ten-year period in the province of Ontario, Canada.   Conducted by a team of researchers at the Institute for Clinical and Evaluative Sciences and the Sunnybrook Health Sciences Centre, the study examined coroner's reports for all deaths occurring between 1990 and 2010.   Deaths were defined as opioid-related if toxicological screening after death showed opioid concentrations high enough to cause death or if a combination of drugs contributed to death.   The researchers then calculated the annual rate of opioid-related deaths as well as demographic statistics.    Based on age at the time of death, the researchers also calculated years of potential life lost (YLL) and broke down the deaths into different age groups (including adolescent, young adult, middle-aged adult, etc.).  

Over the twenty-year period studied, there were 5,935 opioid-related deaths in Ontario.   Of these, the median age was 42 years and 64.4 percent were men.   Perhaps not surprisingly, over 90 percent of the opioid-related deaths involved people living in an urban neighbourhood.   The researchers also found a 242 percent rise in deaths from 12.2 per million in 1991 (127 deaths annually) to 41.6 deaths per million in 2010 (550 deaths annually).    With the exception of the youngest age group (0 to 14),  the rise in opioid-related deaths occurred in all age groups.   Of those age groups however, the highest increase was in people aged 25 to 34 years (rising from 3.3 percent in 1991 to 12.1 percent in 2010).   There was also a sixfold increase for people aged 15 to 24 and 55 to 64 years.  The annual rate of year of potential life lost also rose from 7006 years in 1992 to 21,927 years lost in 2010.   The opioid-related deaths of people aged 25 to 54 accounted for almost 80 percent of years lost. 

So what conclusions can be made from these findings?  Not only have premature deaths due to opioids risen spectacularly over the past 20 years, but almost one in eight deaths occurring among people aged 24 to 35 years appear to involve an opioid.   These figures do not take into account those deaths that were drug-related even though they were link to other causes.   Even focusing on opioid-related deaths exclusively, the number of years lost due to premature mortality are staggering.   Not did the years lost nearly double from 2001 to 2010, but they were greater than similar figures for alcohol and HIV/AIDS.  

Though these results match  other studies showing  number of lives lost worldwide due to opioids,  using coroner's reports allows for greater accuracy in determining cause of death.    The researchers also suggest that focusing on opioid-related deaths may underestimate the impact of opioid addiction on society however.   Since many opioid addicts will experience years of poor health before dying or may die of other causes,  these study results may not reflect the full extent of health problems caused by opioid abuse. 

Still, while opioid abuse appears linked to premature death, especially among young adults, there is no doubt that proper use of opioid-based painkillers can benefit  countless people suffering from chronic pain.    It is more important than ever that any opioid-based medication be carefully monitored by health professionals to avoid problems that could lead to misuse and premature death.   These study results also highlight the deadly consequences of dangerous practices such as "doctor shopping" and using opioid-based street drugs.   While many chronic pain patients may feel that they are not getting the pain relief they need, these medications should only be used as prescribed by physicians.

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