Extramedical opioid use significantly increases all-cause mortality

  • JAMA Psychiatry

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • All-cause mortality worldwide was significantly higher among people using extramedical opioids than among those who do not, across a range of causes.
  • Noncommunicable diseases accounted for almost one-quarter of deaths and infectious diseases, and trauma accounted for almost 20% of deaths.

Why this matters

  • The findings point to the need for a greater emphasis on a combination approach that includes opioid agonist treatment, needle exchange programs, and greater naloxone availability, in addition to HIV and hepatitis C treatments.

Study design

  • A meta-analysis of 124 studies after search across MEDLINE, PsycINFO, and Embase published during 2009-2019.
  • Outcomes: all-cause mortality.
  • Funding: Australian Government Department of Health under the Drug and Alcohol Program.

Key results

  • People who used extramedical opioids had higher risk for all-cause mortality (1.59/100 person-years; 95% CI, 1.40-1.80/100 person-years; I2=99.7%).
  • Highest all-cause mortality was observed in South Asia (7.62/100 person-years; 95% CI, 4.84-12.00/100 person-years) and the lowest was in Australasia (0.80/100 person-years; 95% CI, 0.67-0.96/100 person-years).
  • Key causes for excess mortality (95% CIs) in people who used extramedical opioids:
    • Noncommunicable diseases: 24.1% (17.1%-31.2%);
    • Infectious diseases: 19.7% (11.7%-27.8%); and
    • Trauma: 18.1% (12.6%-23.7%).

Limitations

  • Heterogeneity among studies.

Coauthored with Chitra Ravi, MPharm