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All-cause and overdose mortality risk among people prescribed opioids: a systematic review and meta-analysis


Larney, S and Peacock, A and Tran, LT and Stockings, E and Santomauro, D and Santo Jr, T and Degenhardt, L, All-cause and overdose mortality risk among people prescribed opioids: a systematic review and meta-analysis, Pain Medicine, 21, (12) pp. 3700-3711. ISSN 1526-2375 (2020) [Refereed Article]

Copyright Statement

VC The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.

DOI: doi:10.1093/pm/pnaa214


Objective: To estimate all-cause and overdose crude mortality rates and standardized mortality ratios among people prescribed opioids for chronic noncancer pain and risk of overdose death in this population relative to people with similar clinical profiles but not prescribed opioids.

Design: Systematic review and meta-analysis.

Methods: Medline, Embase, and PsycINFO were searched in February 2018 and October 2019 for articles published beginning 2009. Due to limitations in published studies, we revised our inclusion criteria to include cohort studies of people prescribed opioids, excluding those studies where people were explicitly prescribed opioids for the treatment of opioid use disorder or acute cancer or palliative pain. We estimated pooled all-cause and overdose crude mortality rates using random effects meta-analysis models. No studies reported standardized mortality ratios or relative risks.

Results: We included 13 cohorts with 6,029,810 participants. The pooled all-cause crude mortality rate, based on 10 cohorts, was 28.8 per 1000 person-years (95% CI = 17.9-46.4), with substantial heterogeneity (I2 = 99.9%). The pooled overdose crude mortality rate, based on six cohorts, was 1.1 per 1000 person-years (95% CI = 0.4-3.4), with substantial heterogeneity (I2 = 99.5%), but indications for opioid prescribing and opioid exposure were poorly ascertained. We were unable to estimate mortality in this population relative to clinically similar populations not prescribed opioids.

Conclusions: Methodological limitations in the identified literature complicate efforts to determine the overdose mortality risk of people prescribed opioids. There is a need for large-scale clinical trials to assess adverse outcomes in opioid prescribing, especially for chronic noncancer pain.

Item Details

Item Type:Refereed Article
Keywords:chronic non-cancer pain, mortality, opioids, overdose, poisoning
Research Division:Psychology
Research Group:Applied and developmental psychology
Research Field:Applied and developmental psychology not elsewhere classified
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Peacock, A (Miss Amy Peacock)
ID Code:142999
Year Published:2020
Web of Science® Times Cited:1
Deposited By:Psychology
Deposited On:2021-02-19
Last Modified:2021-05-27

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