Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases

• DOI: 10.7326/m17-1907
• Publication Date: 2018-02-12T23:31:04Z
• Authors: Andrew D. Wiese; Marie R. Griffin; William Schaffner; C. Michael Stein; Robert A. Greevy; Edward F. Mitchel; Carlos G. Grijalva
• Keywords: Nested case-control study

Background: Although certain opioid analgesics have immunosuppressive properties and increase the risk for infections in animals, clinical effects of prescription use on infection among humans are unknown. Objective: To test hypothesis that is an independent factor invasive pneumococcal disease (IPD). Design: Nested case–control study. Setting: Tennessee Medicaid database linked to Medicare Active Bacterial Core surveillance system databases (1995 2014). Patients: 1233 case patients with IPD aged 5 years older matched 24 399 control participants by diagnosis date, age, county residence. Measurements: Opioid was measured basis pharmacy fills. Invasive defined isolation Streptococcus pneumoniae from a normally sterile site. The odds current were compared between groups, accounting known factors. Secondary analyses categorized characteristics, applied score assure comparability exposure analyzed pneumonia nonpneumonia cases separately. Results: Persons group had greater than being users (adjusted ratio [aOR], 1.62 [95% CI, 1.36 1.92]). Associations strongest opioids long acting (aOR, 1.87 [CI, 1.24 2.82]), high potency 1.72 1.32 2.25]), or used at dosages (50 90 morphine milligram equivalents [MME]/d: aOR, 1.71 1.22 2.39]; ≥90 MME/d: 1.75 1.33 2.29]). Results consistent when taken into account Limitations: Unmeasured confounding measurement error, although sensitivity suggested neither likely affect results. Actual other nonprescription (such as illicit use) not measured. Conclusion: associated increased represents novel these diseases. Primary Funding Source: National Institutes Health.