Prescription Opioids and Infection Risk: Research and Caution Needed
Authors: Sascha Dublin, Michael Von Korff
Journal: Annals of Internal Medicine (2018)

Editorials20 March 2018Prescription Opioids and Infection Risk: Research and Caution NeededSascha Dublin, MD, PhD and Michael Von Korff, ScDSascha Dublin, MD, PhDKaiser Permanente Washington Health Research Institute and University of Washington, Seattle, Washington (S.D.)Search for more papers by this author and Michael Von Korff, ScDKaiser Permanente Washington Health Research Institute, Seattle, Washington (M.V.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0001 Annals Author Insight Video - Sascha Dublin, MD, PhD In this video, Sascha Dublin, MD, PhD, offers additional insight into the article, "Prescription Opioids and Infection Risk: Research and Caution Needed." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In their report in Annals, Wiese and colleagues (1) provide evidence that prescription opioids are associated with an increased risk for serious infections. In 2015, an estimated 92 million U.S. adults—more than 1 in 3—used a prescription opioid (2). Because opioids are prescribed so widely despite inadequate data about their safety and efficacy (3), how should clinicians and scientists respond to these disturbing epidemiologic findings?Although opioid addiction and overdose have received much attention as risks of prescription opioid use, remarkably little consideration has been given to another potential risk: infection. Three decades of basic science and animal studies have ...References1. Wiese AD, Griffin MR, Schaffner W, Stein CM, Greevy RA, Mitchel EF, et al. Opioid analgesic use and risk for invasive pneumococcal diseases. A nested case–control study. Ann Intern Med. 2018;168:396-404. doi:10.7326/M17-1907 LinkGoogle Scholar2. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription opioid use, misuse, and use disorders in U.S. adults: 2015 national survey on drug use and health. Ann Intern Med. 2017;167:293-301. [PMID: 28761945]. doi:10.7326/M17-0865. LinkGoogle Scholar3. Von Korff M, Kolodny A, Deyo RA, Chou R. Long-term opioid therapy reconsidered. Ann Intern Med. 2011;155:325-8. [PMID: 21893626]. doi:10.7326/0003-4819-155-5-201109060-00011 LinkGoogle Scholar4. Shavit Y, Terman GW, Lewis JW, Zane CJ, Gale RP, Liebeskind JC. Effects of footshock stress and morphine on natural killer lymphocytes in rats: studies of tolerance and cross-tolerance. Brain Res. 1986;372:382-5. [PMID: 3011211] CrossrefMedlineGoogle Scholar5. Beilin B, Martin FC, Shavit Y, Gale RP, Liebeskind JC. Suppression of natural killer cell activity by high-dose narcotic anesthesia in rats. Brain Behav Immun. 1989;3:129-37. [PMID: 2477090] CrossrefMedlineGoogle Scholar6. Sacerdote P. Opioids and the immune system. Palliat Med. 2006;20 Suppl 1:s9-15. [PMID: 16764216] MedlineGoogle Scholar7. Wiese AD, Griffin MR, Stein CM, Mitchel EF, Grijalva CG. Opioid analgesics and the risk of serious infections among patients with rheumatoid arthritis: a self-controlled case series study. Arthritis Rheumatol. 2016;68:323-31. [PMID: 26473742] doi:10.1002/art.39462 CrossrefMedlineGoogle Scholar8. Dublin S, Walker RL, Jackson ML, Nelson JC, Weiss NS, Von Korff M, et al. Use of opioids or benzodiazepines and risk of pneumonia in older adults: a population-based case-control study. J Am Geriatr Soc. 2011;59:1899-907. [PMID: 22091503] doi:10.1111/j.1532-5415.2011.03586.x CrossrefMedlineGoogle Scholar9. Sacerdote P, Manfredi B, Mantegazza P, Panerai AE. Antinociceptive and immunosuppressive effects of opiate drugs: a structure-related activity study. Br J Pharmacol. 1997;121:834-40. [PMID: 9208156] CrossrefMedlineGoogle Scholar10. Sacerdote P, Bianchi M, Gaspani L, Manfredi B, Maucione A, Terno G, et al. The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients. Anesth Analg. 2000;90:1411-4. [PMID: 10825330] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Kaiser Permanente Washington Health Research Institute and University of Washington, Seattle, Washington (S.D.)Kaiser Permanente Washington Health Research Institute, Seattle, Washington (M.V.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0001.Corresponding Author: Sascha Dublin, MD, PhD, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101; e-mail, dublin.[email protected]org.Current Author Addresses: Drs. Dublin and Von Korff: Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.This article was published at Annals.org on 13 February 2018. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Sascha Dublin, MD, PhD In this video, Sascha Dublin, MD, PhD, offers additional insight into the article, "Prescription Opioids and Infection Risk: Research and Caution Needed." FiguresReferencesRelatedDetailsSee AlsoOpioid Analgesic Use and Risk for Invasive Pneumococcal Diseases Andrew D. Wiese , Marie R. Griffin , William Schaffner , C. Michael Stein , Robert A. Greevy , Edward F. Mitchel Jr. , and Carlos G. 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Grijalva, MD, MPHOpioid use increases risk of invasive pneumococcal disease 20 March 2018Volume 168, Issue 6Page: 444-445KeywordsDrug safetyEpidemiologyFrailtyImmunosuppressivesObservational studiesOpioidsPneumoniaRheumatoid arthritisRisk managementSafety ePublished: 13 February 2018 Issue Published: 20 March 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...