-- Randy Dotinga
MONDAY, Dec. 13 (HealthDay News) -- Two new studies suggest that
Medicare patients who take opioid painkillers such as codeine,
Vicodin or Oxycontin face higher health risks, including death,
heart problems or fractures, compared to those taking non-opioid
However, it's not clear if the painkillers are directly
responsible for the differences in risk, experts said, and other
factors could play a role. And one pain specialist who's familiar
with the findings said they don't reflect the experiences of
doctors who've prescribed the drugs.
In one study, researchers examined a database of Medicare
recipients in two states who were prescribed one of five kinds of
opiod painkillers from 1996-2005. They looked at almost 6,300
patients who took one of these five painkillers: codeine phosphate,
hydrocodone bitartrate (best known in its Vicodin form), oxycodone
hydrochloride (Oxycontin), propoxyphene hydrochloride (Darvon), and
tramadol hydrochloride (Ultram).
Those who took codeine were 1.6 times more likely to have
suffered from cardiovascular problems after 180 days, while
patients on hydrocodone seemed to be at higher risk of fractures
than those who took tramadol and propoxyphene.
After 30 days, those who took oxycodone were 2.4 times more
likely to die than those taking hydrocodone, and codeine users were
twice as likely to die, although the number of deaths was
The study authors caution that their findings are surprising in
some ways and need to be confirmed by further research.
Commenting on the study, Dr. Russell K. Portenoy, chairman of
the department of pain medicine and palliative care at Beth Israel
Medical Center in New York City, said that the findings are of
limited value because many other factors could explain the
differences between the drugs, such as how fast physicians ramped
up the doses of patients.
"I would suggest that readers note this as an observation and wait for the next set of studies to try to figure out if there's any reality in there in terms of risk," he said.
A second study published in the same issue of the journal
compared opioid painkillers against non-opioid analgesics, and
found that patient "adverse events" were more likely when an opioid
A team led by Dr. Damiel H. Solomon of Brigham and Women's
Hospital, Boston, compared the safety of opioids against
non-steroidal anti-inflammatory drugs (NSAIDs, which include
aspirin, ibuprofen and naproxen) and "coxib" drugs such as Celebrex
(celecoxib). They tracked outcomes for almost 13,000 Medicare
recipients who took such pain relievers between 1999 and 2005.
The Boston team found that patients on opioids had higher rates
of adverse events generally than did people taking an NSAID or a
coxib drug. For example, 101 of every 1,000 prescription opioid
users suffered a fracture in a given year versus 19 of every 1,000
people taking another type of painkiller. Coxibs and opioids were
also associated with a higher risk for cardiac events compared to
NSAID use, the team found.
What to do if you're taking an opioid? "There's no question that
opioid drugs carry important risks," Portenoy said. "If you have
chronic pain, your doctor should optimize the dosing and be
managing the risk: not only the risk of side effects and toxicities
but also the risk of things like drug abuse."
There's more on painkillers at the
U.S. National Library of Medicine.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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