Nashville, TN—With all of the other consequences of burgeoning use and misuse of opioid painkillers, here’s a new concern: Patients prescribed the drugs have a significantly increased risk of infections likely to require hospitalization, compared with nonusers.

The study, published recently in Annals of Internal Medicine, found that those using opioids had a 1.62 times higher risk of invasive pneumococcal diseases.

The Vanderbilt University Medical Center–led study points out that invasive pneumococcal diseases are serious infections caused by the Streptococcus pneumoniae bacteria, with mortality ranging from 5% to 20% and including meningitis, bacteremia, and invasive pneumonia.

“The association between opioid use and the risk of invasive pneumococcal diseases was strongest for opioids used at high doses, those classified as high potency and long-acting, which would be the extended release or controlled release formulations,” explained lead author Andrew Wiese, PhD, MPH, postdoctoral research fellow in the Department of Health Policy at Vanderbilt’s School of Medicine.

“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 added.

Although the link had been established in animal studies, whether opioid use in humans had the same effect remained unclear. To determine that, the researchers reviewed Tennessee Medicaid Data to measure daily prescription opioid exposure for each patient and then compared it with a population-based surveillance system conducted in partnership with the Tennessee Department of Health and the CDC to monitor invasive infectious diseases in Tennessee.

A significant association was determined between opioid use and the risk of laboratory-confirmed invasive pneumococcal diseases, study authors report.

In an accompanying editorial, Sascha Dublin, MD, and Michael von Korff, ScD, from the Kaiser Permanente Washington Health Research Institute suggest the research provides, “...cautionary evidence of a higher infection risk with prescription opioid use, suggesting the need for prudent steps to protect patients...” The commentators recommend that “opioid prescribing should be consistently cautious and closely monitored among all patients, especially those at increased risk for infections, who may be particularly susceptible to harm.”

Weise concurred, noting, “The findings from our study are clinically relevant. Providers should consider these results when making pain management decisions.”
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