Prescription opioids tied to risk for invasive pneumococcal disease

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Takeaway

  • Opioid use, especially long-acting, high-potency formulations, is consistently, strongly, and independently associated with invasive pneumococcal disease (IPD) risk.

Why this matters

  • Judicious, cautious prescribing should consider more than potential for drug addiction or overdose.
  • IPD fatalities are high among adults (ranging from 5% to 7% for pneumonia; 20% for bacteremia; 22% for meningitis), and may be even higher in the elderly.
  • Opioids are a modifiable risk factor in these groups and others (eg, decreased immune functioning, chronic high-risk medical conditions).

Key results

  • 1233/221,096 patients had laboratory-confirmed IPD (73.9% [n=911] with invasive pneumonia).
  • 25.2% (n=311) patients vs 14.4% (n=3521) control patients were current opioid users.
  • Current opioid use was strongly associated with IPD (aOR, 1.62; 95% CI, 1.36-1.92).
  • Risk association was greatest for opioids that were long-acting (aOR, 1.87; 95% CI, 1.24-2.82), high-potency (aOR, 1.72; 95% CI, 1.32-2.25), and highest dose (≥90 morphine milligram equivalents/day: aOR, 1.75; 95% CI, 1.33-2.29).

Study design

  • Retrospective, nested, case-control study analyzing opioid use and risk for laboratory-confirmed IPD in a Tennessee Medicaid population.
  • Funding: NIH.

Limitations

  • Opioid use limited to pharmacy prescriptions.
  • Study underpowered to evaluate direct drug-drug comparisons.
  • Residual confounding.
  • Findings are nongeneralizable.