Burden and treatment of chronic obstructive pulmonary disease among people using illicit opioids: matched cohort study in England

Abstract

ObjectiveTo understand the burden of chronic obstructive pulmonary disease among people who use illicit opioids such as heroin, and evaluate inequalities in treatment.DesignCohort study.SettingPatients registered at primary care practices in England.Participants106 789 patients in the Clinical Practice Research Datalink with illicit opioid use recorded between 2001 and 2018, and a subcohort of 3903 patients with a diagnosis of chronic obstructive pulmonary disease. For both cohorts, the study sampled a comparison group with no history of illicit opioids that was matched by age, sex, and general practice.Main outcome measuresIn the base cohort: diagnosis of chronic obstructive pulmonary disease and death due to the disease. In the subcohort: five treatments (influenza vaccine, pneumococcal vaccine, pulmonary rehabilitation, bronchodilators or corticosteroids, and smoking cessation support) and exacerbations requiring hospital admission.Results680 of 106 789 participants died due to chronic obstructive pulmonary disease, representing 5.1% of all cause deaths. Illicit opioid use was associated with 14.59 times (95% confidence interval 12.28 to 17.33) the risk of death related to chronic obstructive pulmonary disease, and 5.89 times (5.62 to 6.18) the risk of a diagnosis of the disease. Among patients with a new diagnosis, comorbid illicit opioid use was associated with current smoking, underweight, worse lung function, and more severe breathlessness. After adjusting for these differences, illicit opioids were associated with 1.96 times (1.82 to 2.12) times the risk of exacerbations requiring hospital admission, but not associated with a substantially different probability of the five treatments.ConclusionsDeath due to chronic obstructive pulmonary disease is about 15 times more common among people who use illicit opioids than the general population. This inequality does not appear to be explained by differences in treatment, but late diagnosis of the disease among people who use illicit opioids might contribute.

Safe inhalation pipe provision (SIPP): protocol for a mixed-method evaluation of an intervention to improve health outcomes and service engagement among people who use crack cocaine in England

“…Use of homemade pipes can exacerbate respiratory conditions – placing people at heightened risk of COVID-19 related morbidity if they contract the virus [ 12 ]. High prevalence of COPD among this population [ 35 , 62 ] is a continuing concern even as COVID-19 risk diminishes with vaccine rollout.…”

Health‐care resource use among patients who use illicit opioids in England, 2010–20: A descriptive matched cohort study

“…Detailed studies might therefore focus upon specific areas where there are validated GP coding phenotypes. A recent study of patients diagnosed with COPD who use illicit opioids suggested that opioid use was not associated with lower uptake of treatments such as pulmonary rehabilitation and vaccination against respiratory infections [47]. This may further suggest that people who use illicit opioids do access GPs despite the barriers documented in interviews that some may experience.…”

Chronic obstructive pulmonary disease in heroin users: An underappreciated issue with clinical ramifications

“…Although often present from a younger age than is expected in smokers or the general population, COPD often goes underdiagnosed and undertreated in heroin users [1,3], as do many health complications in this population.…”

“…Chronic obstructive pulmonary disease (COPD) is common among heroin users, particularly smokers of heroin, occurring at rates well in excess of the general population [1][2][3]. There is evidence of both early onset and accelerated progression [4], with fatalities secondary to respiratory failure occurring before the age of 40 years reported [5].…”

“…Given these risk factors, how common is early onset COPD among heroin users? It is estimated that 40% of heroin users meet criteria for COPD [1]. Among smokers of heroin, the prevalence is as high as 50% [2,4,5,8] and a fifth among injectors [1,2,10,11].…”