Immunosuppressive Effects of Opioids—Clinical Relevance

Abstract

Opioid-induced immunosuppression has been demonstrated in cell culture experiments and in animal models. This is in striking contrast to the paucity of confirmatory studies in humans. This review describes the basic pharmacokinetics and -dynamics of opioid use in patients. It summarizes the major findings on opioid use and infectious complications in intensive care unit (ICU) patients, in patients with acute or chronic non-malignant pain, and in intravenous drug users (IDU). The limitations of studies in each area are discussed. For example, ethical concerns may complicate randomized placebo-controlled trials (RCT) in acute postoperative pain and for a large part of ICU patients. Importantly, most studies in patients with chronic (non-malignant) pain only inadequately report infectious complications in relation to opioid use since their incidence is usually not considered to be drug related. Infectious complications in IDUs are very frequent but cannot easily be distinguished from risk behavior or risk environment. In summary, convincing clinical evidence is lacking that opioids per se increase the rate of infectious complications in most patient categories. From a clinical standpoint, important unresolved issues are i) selection of relevant animal models, ii) opioid selection and discontinuation, and iii) the role of coexisting diseases and concomitant other medications.

G protein-coupled receptors as therapeutic targets for multiple sclerosis

“…It has also been noticed for a long time that opioids can alter the immune responses. Acute or chronic administration of opioids is known to have inhibitory effects on humoral and cellular immune responses, including antibody production, natural killer-lymphocyte activity, cytokine expression, and phagocytic activity [132][133][134]. Increased morbidity and mortality due to artificial infection and faster cancer progression have been well docu- mented in animal studies with morphine treatment [134,135].…”

Where now for opioids in chronic pain?

“…8 Longer term harms include fractures, falls, endocrine and immune disturbance, disturbance of nocturnal respiratory control, and consequent cardiovascular adverse events. 11–16 The prevalence of addiction to prescription opioids is variably reported and may be context-specific. One systematic review suggested that addiction occurs in 8%–12% of individuals taking prescription opioids, but most data in the review derive from the USA and we have no definitive figures for European populations.…”

Drugs of Abuse Effects on Immunity and Microbial Pathogenesis

“…Although opioid-induced immunosuppression has been demonstrated in cell culture experiments and in animal models, there is a paucity of confirmatory studies in humans. The review by Brack et al describes the basic pharmacokinetics and pharmacodynamics of opioid use in patients (Brack et al 2011). It summarizes the major findings of opioid use and infectious complications in intensive care unit patients, in patients with acute or chronic non-malignant pain, and in IDU.…”