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Vanderbilt researchers have published a study that shows opioid painkillers — particularly in their most potent forms — put patients at significantly higher risk of deadly infections. The findings were released Monday in the Annals of Internal Medicine.
Using data from the 1.4 million people on TennCare and comparing it with an infection tracking database, a team from Vanderbilt found that people on opioids have a roughly 60 percent higher risk of contracting pneumonia and meningitis — 1.62 times the rate for non-opioid users. And the infections were severe enough to land them in the hospital.
Lead author Andrew Wiese says this should cause physicians to pause before prescribing opioids to elderly patients or those with suppressed immune systems, like those in chemotherapy.
"Those are a group that — because they're at an increased risk for infection — we really want to make sure that providers are considering these immunosuppressive effects of opioids when making pain management decisions," he said in a prepared video statement.
Wiese notes that some opioids don't seem to suppress the immune system like others, which he says needs more study. Before this research, the link between opioids and infections had only been shown in animals. The effects in humans was unclear.
“We also found that opioids previously described as immunosuppressive in prior experimental studies conducted in animals had the strongest association with invasive pneumococcal diseases in humans,” Wiese said.
A unique feature of the Vanderbilt research was using laboratory-confirmed infections through the Active Bacterial Core surveillance database housed at the university and run in tandem with the Tennessee Department of Health.
"The sources of data allowed us to reconstruct and compare the history of opioid exposures in those subjects with and without invasive pneumococcal diseases," senior author and Vanderbilt health policy professor Carlos Grijalva said in a statement.
The research is globally relevant as increased opioid usage has elevated interest in adverse effects. But the study could have particular local significance and sway current policy debates, given that the data comes from TennCare. The state's Medicaid program has implemented new restrictions on opioid prescribing in recent months and the state legislature is considering broader limits.
Vanderbilt's study was funded by the National Institutes of Health — the National Institute on Aging.
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