COVID-19 outcomes among adult patients treated with long-term opioid therapy for chronic non-cancer pain in the USA: a retrospective cohort study

• Published in: BMJ open 2021-11, Vol.11 (11), p.e056436-e056436
• Main Authors: Tuan, Wen-Jan, Spotts, Hannah, Zgierska, Aleksandra E, Lennon, Robert P
• Format: Article
• Language: English
• Subjects: Cancer; Cohort analysis; cohort study; Coronaviruses; COVID-19; Diagnostic tests; Drug use; Electronic health records; Epidemiology; Health services utilization; Infections; Laboratories; Mental depression; Mental disorders; Morbidity; Mortality; Narcotics; opioids; Pain; Pandemics; Patients; Severe acute respiratory syndrome coronavirus 2; Socioeconomic factors; Ventilators
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-056436

ObjectivePatients treated with long-term opioid therapy (LTOT) are known to have compromised immune systems and respiratory function, both of which make them particularly susceptible to the SARS-CoV-2 virus. The objective of this study was to assess the risk of developing severe clinical outcomes among COVID-19 non-cancer patients on LTOT, compared with those without LTOT.Design and data sourcesA retrospective cohort design using electronic health records in the TriNetX research database.Participants and setting418 216 adults diagnosed with COVID-19 in January–December 2020 from 51 US healthcare organisations: 9558 in the LTOT and 408 658 in the control cohort. They did not have cancer diagnoses; only a small proportion might have been treated with opioid maintenance for opioid use disorder.ResultsPatient on LTOT had a higher risk ratio (RR) than control patients to visit an emergency department (RR 2.04, 95% CI 1.93 to 2.16) and be hospitalised (RR 2.91, 95% CI 2.69 to 3.15). Once admitted, LTOT patients were more likely to require intensive care (RR 3.65, 95% CI 3.10 to 4.29), mechanical ventilation (RR 3.47, 95% CI 2.89 to 4.15) and vasopressor support (RR 5.28, 95% CI 3.70 to 7.53) and die within 30 days (RR 1.96, 95% CI 1.67 to 2.30). The LTOT group also showed increased risk (RRs from 2.06 to 3.98, all significant to 95% CI) of more-severe infection (eg, cough, dyspnoea, fever, hypoxaemia, thrombocytopaenia and acute respiratory distress syndrome). Statistically significant differences in several laboratory results and other vital signs appeared clinically negligible.ConclusionCOVID-19 patients on LTOT were at higher risk of increased morbidity, mortality and healthcare utilisation. Interventions to reduce the need for LTOT and to increase compliance with COVID-19 protective measures may improve outcomes and reduce healthcare cost in this population. Prospective studies need to confirm and refine these findings.