Mortality among long-term prescription opioid users

Background and Aims: Chronic pain is a major public health problem, affecting more than 30% of the population worldwide. Individuals with chronic pain conditions with long-term pharmacological treatment with opioids may have higher mortality rates than the general population due to the increased risk of overdose, unintentional injuries, and suicide. There is currently limited research investigating mortality in long-term prescription opioid users. This study aimed to study all-cause and cause-specific mortality among long-term prescription opioid users.

Design: A national longitudinal health registry study using linked data from the Norwegian Prescribed Drug Registry (NorPD), the Cancer Registry of Norway, and the Norwegian Cause of Death Registry.

Setting: Norway. 

Participants: All patients aged 15-69 years with long-term prescription opioid use for pain conditions registered in the NorPD between 2012 and 2019 were included (n = 140,000)1 in addition to the general population in Norway. 

Measurements:  Sex-specific age-standardized mortality ratios (SMR) for all-cause and cause-specific mortality, including opioid overdoses (ICD-10 codes X40-X49), suicide (X60-X84 and Y87.0), and other unnatural causes including accidents (V01-V89) for the whole study population aged 15-69 years and different age groups (15-34, 35-54, and 55-69 years) were calculated.

Findings:  For all-cause mortality, the SMR was 1.74 (95% CI = 1.70-1.78) for males and 1.37 (95% CI = 1.33-1.40) for females. The SMR decreased with age and was highest for males and females aged 15-34 years (SMR = 3.19, 2.79-3.63, and SMR = 2.93, 2.45-3.41, respectively). Cause-specific mortality was higher in long-term prescription opioid users compared to the general population. The SMRs were particularly high in overdose deaths and accidents in both males and females, with the youngest age group experiencing the highest impact.

Conclusions: Patients with long-term prescription opioid use had a higher mortality compared to the general population. The highest mortality ratio was observed in the youngest age group for both males and females. 

1Hamina, A., Hjellvik, V., Handal, M., Odsbu, I., Clausen, T., & Skurtveit, S. (2022). Describing long-term opioid use utilizing Nordic prescription registers—A Norwegian example. Basic & Clinical Pharmacology & Toxicology, 130(4), 481-491. https://doi.org/10.1111/bcpt.13706