Increased risk of death from any opioid use in people with dementia, study says | Cnn

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People over age 65 with dementia were four times more likely to die within the first six months after starting an opioid for pain, and six times more likely to die if the opioid was strong, such as morphine. oxycodone or fentanyl, according to a new study.

Death was 11 times more likely within the first two weeks after starting any opioid prescription, according to the unpublished study, which was presented Tuesday at the 2023 International Alzheimer’s Conference in Amsterdam.

Strong pain relievers can affect automatic impact functions, such as heart rate, breathing and swallowing, and older individuals may already have problems with these things, said Maria Carrillo, medical director of the Alzheimer’s Association, who didn’t was involved in the study.

The opioid crisis in the United States is a national public health emergency, reports the Administration for Strategic Preparedness and Response. Overdoses have skyrocketed from 47,600 in 2019 to more than 80,000 in 2021, with no end in sight, according to statistics from the National Institute on Drug Abuse and the US Centers for Disease Control and Prevention.

During that time the use of strong opioids, particularly transdermal formulations, which are applied to the skin, has become increasingly common among older adults with dementia, said lead study author Dr. Christina Jensen. Dahm, a neurologist and senior researcher at the Danish Dementia Research Center at Rigshospitalethospital in Cofenhagen, Denmark.

Seniors with dementia are often frail and have severe brain impairment and we assume this is why they cannot tolerate opioids, Jensen-Dahm said in an email. We do not assume that they are taking drugs recreationally. We assume that they die because, due to their brain disorder, they are unable to tolerate opioids.

Stronger opioids increased the risk

The study analyzed data on more than 75,000 Danes over the age of 65 diagnosed with dementia over a 10-year period between 2008 and 2018. Of these, 42% had redeemed a prescription for opioids. The study followed that group for 180 days after they started taking opioids, comparing their death rate to people with dementia in the study who hadn’t taken opioids.

More than 33 percent of the group starting an opioid died within the 180-day period, compared with just 6.4 percent of those with dementia who weren’t taking painkillers, according to the study.

According to the study, strong opioids increased the risk of death sixfold and increased even more if a fentanyl transdermal patch was used. If people were given transdermal fentanyl as their first prescription, the death rate rose to 65.3% within the first 180 days, with an eight times higher risk of dying.

The greatest risk of dying from any opioid, however, was during the first 14 days after starting the drug, people with dementia were 11 times more likely to die during the first two weeks. Previous studies have found that it can also occur in the general population starting an opioid, Jensen-Dahm said, but those studies didn’t find the excess mortality risk to be of the same magnitude as our study.

The findings should raise alarm for doctors and families of people with dementia, neurologist Dr. Nicole Purcell, senior director of clinical practice for the Alzheimer’s Association, said in a statement.

These new findings further underscore the need for discussion between the patient, family and physician. Decisions about prescribing pain medications should be carefully weighed and, if used, close patient monitoring is required, Purcell said.

The first choice for pain management should always be nondrug therapy such as exercise, heat, or physical therapy, Jensen-Dahm said, followed by milder pain relievers such as acetaminophen or another nonsteroidal anti-inflammatory drug, if appropriate for that patient.

As stated in the 2022 CDC guidelines, opioid therapy should be considered for pain (acute, subacute, or chronic) only if the benefits are expected to outweigh the risks to the patient, Jensen-Dahm said.

Making decisions for a loved one who is suffering is difficult because with dementia, our loved ones may not be able to convey what they are feeling, Carrillo said.

The message here is that we need to be extra careful when we, as family members and clinicians, make decisions about prescribing opioids for people who are not only older but also affected by dementia, he added. We may be putting that loved one at greater risk.