Researchers identify opioids with highest risk of respiratory depression
A large UK study has teased out which opioids are most strongly associated with respiratory depression.
In patients being treated for non-cancer pain, fentanyl, combination opioid treatments, oxycodone and morphine are associated with higher risks compared to codeine, researchers found.
The analysis of electronic health records from 32,909 adult inpatients at a large hospital in Northwest England also found that patients with chronic respiratory disease may be especially vulnerable to the effects of potent opioids.
They found prescribed fentanyl was associated with more than triple the risk of respiratory depression compared with codeine.
Combinations of opioids carried nearly three times the risk of respiratory depression, the University of Manchester researchers reported in BMC Medicine.
The study showed oxycodone and morphine were linked to significantly higher risks compared with codeine.
When compared directly with morphine, fentanyl still showed almost double the risk, while combination opioids also remained substantially riskier.
A combination of an opioid and a gabapentinoid was associated with a further increased risk in respiratory depression, they found.
It comes after a study last year warned GPs to exercise more caution in prescribing gabapentinoids alongside other medications due to the risk of drug poisoning.
The researchers also looked at dose and found that patients receiving 120 morphine milligram equivalents (MME) per day or more had double the risk of respiratory depression compared with those on less than 50 MME.
Even moderate doses of 31 to 60 MME per day were linked to a measurable increase in risk of respiratory depression, they reported.
Patients with COPD taking fentanyl had a fourfold increase in respiratory depression, the analysis showed.
Senior author Dr Meghna Jani, a senior clinical lecturer at The University of Manchester, said: ‘Opioids remain important medicines for managing severe acute pain.
‘Our findings show that the risks are not the same across all opioid drugs or doses.’
She noted that the detailed hospital electronic health records allowed them to accurately capture when opioids were actually administered to patients, alongside routinely collected vital signs to identify changes in breathing.
‘Understanding how different medicines and combinations affect respiratory safety can help clinicians and patients make more informed prescribing decisions together, as well increasing awareness of what dose thresholds require closer monitoring.’
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