Low-Dose Opioids May be Safe in Patients with Severe Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy

Opioid and benzodiazepine medications have the potential to decrease some symptoms in patients with severe chronic obstructive pulmonary disease (COPD), but their safety in this population is unclear. Researchers analyzed national prospective data from 2249 Swedish adults (≥45 years of age; 59% women) who initiated long-term oxygen therapy for COPD. Exposure to opioids and benzodiazepines was extracted from a national medication registry and defined as ≥1 prescriptions in the 91 days before initiation of oxygen therapy.

• In the 91 days before study entry, 23% of participants had exposure to opioids, 24% to benzodiazepines, and 9% to both.
• 50% of participants died during a median 1.1 years of follow-up.
• Participants who were prescribed higher doses of opioids (>30 mg morphine equivalents in a day) had higher mortality, but those prescribed lower doses (≤30 mg) did not.
• Participants exposed to benzodiazepines had higher mortality, but there was no definite dose-response.
• Participants who were prescribed high concurrent doses of opioids and benzodiazepines had higher mortality, but those prescribed low concurrent doses did not.

Comments:

This study suggests that low-dose opioids may be safe to prescribe for breathlessness in patients with severe COPD on oxygen therapy. Unfortunately, the indication for opioid and/or benzodiazepine therapy was not obtainable from the data registry. It is not known how many participants were in hospice or terminal care, circumstances under which the prescription of opioids and benzodiazepines for symptom relief and comfort generally outweighs concern about mortality risk.

Kevin L. Kraemer, MD, MSc

Reference:

Ekström MP, Bornefalk-Hermansson A, Abernethy AP, Currow DC. Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ. 2014;348:g445.