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 In Respiratory

Older adults with Chronic Obstructive Pulmonary Disorder (COPD) who recently started using opioids have an increased risk of coronary artery disease-related death compared to non-opioid users, researchers at St Michael’s Hospital have found.

Among these patients, new opioid use is associated with a 215 per cent increase in coronary artery disease-related death for long-term care residents, and an 83 per cent increase in coronary artery disease-related death for those who lived at home compared to non-opioid users, according to the study.

The study, published in the European Journal of Clinical Pharmacology, raises concerns about new opioid use among older adults with COPD, a progressive lung disease that causes breathing difficulty, said Dr Nicholas Vozoris, a Respirologist at St Michael’s, and lead author of the study.

Previous research by Dr Vozoris found older adults with COPD who recently started using opioids are also at an increased risk of dying from respiratory reasons compared to non-opioid users.

Previous research has shown about 70 per cent of older adults with COPD use opioids, which is an incredibly high rate of new use in a population that is potentially more sensitive to narcotics,’ explained Dr Vozoris.

Our new findings show there are not only increased risks for coronary artery disease-related death associated with new opioid use, but also increased risk of cardiac-related visits to emergency rooms and hospitalisations.’

Dr Vozoris found that 60 per cent of older adults with COPD living in the community and 67 per cent of long-term care residents were given a new opioid between April 2008 and March 2013. Opioids, including morphine and fentanyl, are prescribed frequently among older adults with COPD to help treat chronic muscle and bone pain, insomnia, as well as persisting cough and shortness of breath despite inhaler therapy.

This class of drugs may offer some relief for this population, but there is also evidence suggesting that opioids can adversely affect cardiac health,’ said Dr Vozoris.

Researchers looked specifically at opioids that were not combined with either Aspirin or Tylenol.

While the findings don’t prove cause and effect, only an association between new opioid use and an increased risk of coronary artery disease-related death, researchers hypothesised that it could be related to these potential side-effects.

One other important reason they might be linked to future risk of heart attacks is because they offer pain relief, which could reduce or take away chest pain that acts as a warning before a cardiac event,’ said Dr. Vozoris.

Without that warning, doctors may not be able to intervene in time.’

Dr Vozoris said that he hoped that clinicians would take these findings into consideration when prescribing opioids to people with COPD.

Coronary artery disease-related death is another potential risk of prescribing an opioid to an already high-risk population,’ he said.

I hope that providers will be more careful about prescribing opioids to COPD patients, and that patients are made aware of the risks so they can be vigilant about potential side-effects.’

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