COVID-19 outcomes among adult patients treated with long-term opioid therapy for chronic non-cancer pain in the USA: a retrospective cohort study

Abstract

ObjectivePatients treated with long-term opioid therapy (LTOT) are known to have compromised immune systems and respiratory function, both of which make them particularly susceptible to the SARS-CoV-2 virus. The objective of this study was to assess the risk of developing severe clinical outcomes among COVID-19 non-cancer patients on LTOT, compared with those without LTOT.Design and data sourcesA retrospective cohort design using electronic health records in the TriNetX research database.Participants and setting418 216 adults diagnosed with COVID-19 in January–December 2020 from 51 US healthcare organisations: 9558 in the LTOT and 408 658 in the control cohort. They did not have cancer diagnoses; only a small proportion might have been treated with opioid maintenance for opioid use disorder.ResultsPatient on LTOT had a higher risk ratio (RR) than control patients to visit an emergency department (RR 2.04, 95% CI 1.93 to 2.16) and be hospitalised (RR 2.91, 95% CI 2.69 to 3.15). Once admitted, LTOT patients were more likely to require intensive care (RR 3.65, 95% CI 3.10 to 4.29), mechanical ventilation (RR 3.47, 95% CI 2.89 to 4.15) and vasopressor support (RR 5.28, 95% CI 3.70 to 7.53) and die within 30 days (RR 1.96, 95% CI 1.67 to 2.30). The LTOT group also showed increased risk (RRs from 2.06 to 3.98, all significant to 95% CI) of more-severe infection (eg, cough, dyspnoea, fever, hypoxaemia, thrombocytopaenia and acute respiratory distress syndrome). Statistically significant differences in several laboratory results and other vital signs appeared clinically negligible.ConclusionCOVID-19 patients on LTOT were at higher risk of increased morbidity, mortality and healthcare utilisation. Interventions to reduce the need for LTOT and to increase compliance with COVID-19 protective measures may improve outcomes and reduce healthcare cost in this population. Prospective studies need to confirm and refine these findings.

Opioid usage and COVID-19 prognosis: A systematic review and meta-analysis

“…A full text review of the remaining 52 studies was then conducted, and 47 records were eliminated since they were reviews, abstract, letters, conferences, without comparison between opioid use and no-opioid use, or without clinical outcomes reported. Therefore, a total of 5 studies with 1,023,224 patients were included in the final analysis [ [22] , [23] , [24] , [25] , [26] ]. The process of study retrieval is shown in Fig.…”

“… Study Region Opioid No opioid Study design Sample size Definition of opioid Adjusted variables NOS score Age Male (%) Age Male (%) Allen [ 22 ] 2020 U.S.A NR NR NR NR Retrospective cohort 11,830 ICD-10 codes F11 (opioid use disorder) Sex, age, race and comorbidity 8 Oh [ 23 ] 2021 South Korea NR NR NR NR Retrospective cohort 7713 All opiates except codeine, dihydrocodeine, hydrocodone, and tramadol. Sex, age, race, annual income level in 2020 and comorbidity 8 Qeadan [ 24 ] 2021 U.S.A 60 (48–70) 502 (49.6) 53 (35–68) 25,298 (49.3) Retrospective cohort 52,312 Measured by past opioid overdose or opioid use disorders recorded in ICD-9 or ICD-10 codes Age, gender, race/ethnicity, insurance, region, diabetes mellitus, asthma, hypertension, hydroxychloroquine, remdesivir, decadron or prednisone, aspirin and plavix 8 Tuan [ 25 ] 2021 U.S.A 52.1 ± 17.1 3764 (39.4) 43.1 ± 17.6 199,947 (48.9) Retrospective cohort 418,216 Individuals are prescribed with opioids in three or more consecutive months or at least 90 days at outpatient settings. Age, sex, race/ethnicity and comorbidities (diabetes, essential hypertension, chronic pulmonary conditions, cardiovascular diseases, mental health disorders) 8 Wiener [ 26 ] 2021 U.S.A 71.8 ± 6.3 3382 (45.1) 74.1 ± 7.3 245,186 (46.9) Retrospective cohort 533,153 The unhealthf...…”

One-year results from the vaccination campaign against COVID-19 infection in 47 million individuals with severe mental disorders and other chronic diseases

“…High doses of opioids might exacerbate the respiratory depression found in COVID-19 patients and their chronic use can trigger opioid tolerance [ 8 ]. The higher doses used during the pandemic might result in greater adverse effects and increased risk of COVID-19 infection and mortality [ 9 – 11 ]. Opioid use disorders have, therefore, been targeted as a population at a particular risk of COVID-19 mortality.…”

Treatment with stimulants and the risk of COVID-19 complications in adults with ADHD

“…The study population consisted of adults (age≥18 years) with ADHD and COVID-19 infection. They were considered to have COVID-19 based on the presence of the ICD-10 diagnostic codes or positive laboratory test results confirming COVID-19 during the 18-month study assessment period (January 1, 2020-June 30, 2021; see Table A.1 for details) ( Tuan et al, 2021 ). Because an individual could have experienced a COVID-19 infection more than once, the first COVID-19 infection episode during the study assessment period was considered the “index” infection.…”

“…The available demographic data included sex (male/female), age, ethnicity (Hispanic/non-Hispanic) and race (White/Black/Other). Data on conditions known to be associated with the COVID-19 illness severity and/or ADHD outcomes included the diagnoses of medical conditions (obesity, diabetes, chronic kidney disease, cardiovascular disorders), ( Yek et al, 2022 , Tuan et al, 2021 ) mental health disorders (depression, anxiety, bipolar), ( Wang et al, 2021a ) and SUDs (tobacco/nicotine, alcohol, cannabis, cocaine, stimulant, opioid) ( Wang et al, 2021b ). Because the ‘current status’ of tobacco use/smoking was unavailable in the TriNetX database, the presence of the tobacco/nicotine use disorder diagnoses was used as the proxy of smoking/tobacco use.…”