Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan

Po-Feng Lee,Wen-Hsuan Hou,Yen-Chin Liu,Chung-Yi Li,Chang-Ta Chiu

doi:10.3390/healthcare9111402

Abstract

(1) Background: The prevalence of opioid use in Taiwan increased by 41% between 2002 and 2014. However, little is known regarding the risk of mortality among long-term opioid analgesics users who do not have cancer. This study investigated this mortality risk with an emphasis on the calendar year and patients’ age and sex. (2) Methods: This retrospective cohort study included 12,990 adult individuals without cancer who were long-term users of opioid analgesics and were randomly selected from the data set of Taiwan’s National Health Insurance program from 2000 to 2012. They were then followed up through 2013. Information on the underlying causes of death was retrieved from the Taiwan Death Registry. Age, sex, and calendar year-standardized mortality ratios (SMRs) of all-cause and cause-specific mortality were calculated with reference to those of the general population. (3) Results: With up to 14 years of follow-up, 558 individuals had all-cause mortality in 48,020 person-years (cumulative mortality: 4.3%, mortality rate: 11.62 per 1000 person-years). Compared with the general population, the all-cause SMR of 4.30 (95% confidence interval (95% CI): 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural (5.04, 95% CI: 3.88–6.45) causes. (4) Conclusions: Long-term opioid analgesics use among individuals without cancer in Taiwan was associated with a significantly increased risk of mortality. The notably increased mortality in younger adults warrants attention. Strategies to reduce long-term opioid analgesics use, especially their overuse or misuse, are in an urgent need.

Highlights

Over the past 20 years, the consumption of opioid analgesics has significantly increased in many North American and European countries
Compared with the general population, the all-cause standardized mortality ratios (SMRs) of 4.30 (95% confidence interval: 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural
Most patients were enrolled at the age of 45 years or older (67.09%), 15.19% of patients became long-term opioid analgesics users during young adulthood (

Summary

Introduction

Over the past 20 years, the consumption of opioid analgesics has significantly increased in many North American and European countries. 2007, opioid consumption in Taiwan increased by 55% from 362 to 560 defined daily doses per million inhabitants per day; Taiwan ranked 56th out of 181 countries and regions worldwide in opioid consumption, according to the 2005–2007 data set of the International. Narcotics Control Board [1]. This trend continued to rise despite the Taiwanese government implementing strict guidelines on the prescription of opioid analgesics. Opioid consumption still increased by 41% between 2002 and 2014 [2]. The potential adverse health impacts of the long-term use of opioid analgesics are of both clinical and public health importance due to the increase in opioid consumption

Methods

Results

Conclusion