Opioids may be associated with increased risk for serious invasive pneumococcal infections

Patients with invasive pneumococcal disease had significantly greater odds than control participants of being current opioid users, and associations were strongest for long-acting opioids, high-potency opioids, and high-dose opioids.

Opioid use was associated with a significantly increased risk for serious invasive pneumococcal infections such as pneumonia and meningitis, a recent study found.

Researchers used Tennessee Medicaid data linked to Medicare and Active Bacterial Core surveillance system databases to evaluate whether prescription opioid use is an independent risk factor for invasive pneumococcal disease. In the nested case-control study, 1,233 case-patients with invasive pneumococcal disease who were ages five years and older were matched to 24,399 control participants by diagnosis date, age, and county of residence. Opioid use was measured according to pharmacy prescription fills, and invasive pneumococcal disease was defined by the isolation of Streptococcus pneumoniae from a normally sterile site. Results were published Feb. 13 by Annals of Internal Medicine.

Patients with invasive pneumococcal disease had significantly greater odds than control participants of being current opioid users (adjusted odds ratio [aOR], 1.62; 95% CI, 1.36 to 1.92). Associations were strongest for long-acting opioids (aOR, 1.87; 95% CI, 1.24 to 2.82), high-potency opioids (aOR, 1.72; 95% CI, 1.32 to 2.25), and high-dose opioids (aOR, 1.71 [95% CI, 1.22 to 2.39] for 50 to 90 morphine milligram equivalents [MME]/d and 1.75 [95% CI, 1.33 to 2.29] for ≥90 MME/d). Results were consistent when the invasive pneumococcal disease risk score was considered and pneumonia and nonpneumonia invasive pneumococcal disease were analyzed separately.

“These findings should be considered when developing IPD [invasive pneumococcal disease] prevention recommendations, including vaccination,” the authors wrote. “Furthermore, this previously unrecognized association between opioid use and IPD highlights the need for judicious use of opioid analgesics that considers both the benefits and risks of these medications. Because the strongest associations were observed for opioids with certain characteristics, these findings should be considered when selecting opioid analgesics for pain management.”

An editorial noted that while this study supported existing evidence that opioids may be associated with a risk for infectious disease, more definitive research is needed. “Reflexive and poorly monitored prescribing of opioid analgesics on the untested assumption that patient outcomes are improved may be harming more patients than we care to admit,” the editorial stated. “Opioid prescribing should be consistently cautious and closely monitored among all patients, especially those at increased risk for infections, who may be particularly susceptible to harm. Cautious prescribing should not be limited to patients deemed at increased risk for drug addiction or overdose.”

In other opioid news, the FDA announced last week that the botanical substance kratom works just as opioids do, following up on its November 2017 public health advisory stating that the drug should not be used recreationally or to treat opioid addiction.

FDA commissioner Scott Gottlieb, MD, said in a statement last week that based on scientific information in the literature, the FDA's own computational modeling studies, and reports of kratom's adverse effects in human, the agency feels confident in calling the compounds found in kratom opioids.

“Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids,” the statement said. “There is no evidence to indicate that kratom is safe or effective for any medical use. And claiming that kratom is benign because it's ‘just a plant’ is shortsighted and dangerous.” Kratom is associated with novel risks because of variations in how it is formulated, sold, and used, Dr. Gottlieb noted in the statement, urging individuals seeking treatment for opioid addiction who are being told kratom can be effective to seek help from a clinician.