Older patients with arthritis who take narcotic or opioid-based painkillers appear to face a higher risk for bone fractures, heart attacks and death, compared to those using other, non-narcotic painkillers, according to a study published in the Archives of Internal Medicine.
“Doctors should not assume that opioids are a safer alternative,” to other painkillers, Dr. Daniel H. Solomon, the study’s lead researcher, told The New York Times.
The Times said the study appears to be the first large-scale effort to look at the comparative risks for the elderly of taking different classes of painkillers. The use of narcotic or opiod painkillers–a category including codeine, Vicodin and Oxycontin–has increased in recent years because of a belief that they were safer for older patients than non-narcotic drugs such as Advil and Motrin.
Researchers at Brigham and Women’s Hospital in Boston reviewed the records of Medicare recipients in New Jersey and Pennsylvania, treated from 1999 through 2005, who were diagnosed with osteoarthritis or rheumatoid arthritis. Using statistical methods they divided the mostly female patients, whose average age was 80, into three painkiller groups.
The groups were: narcotic-based drugs; nonsteroidal anti-inflammatory drugs, or NSAIDs, such as Advil or Aleve; and another class of pain drugs called coxibs, including Celebrex as well as Vioxx, which has been pulled from the market.
Although the researchers could not identify all the factors that may have contributed to adverse effects, they found that patients taking narcotic painkillers faced twice as high a risk of death compared to those taking a nonsteroidal anti-inflammatory drug. Patients on narcotics-based painkillers were also four times more likely to experience a compound bone fracture, apparently as a result of a fall, and twice as likely to have a heart attack. The painkillers in the coxibs group carried the same cardiovascular risk as the narcotic drugs.
One of the primary reasons doctors have advocated the use of narcotics-based painkillers is that they were believed to reduce gastrointestinal bleeding, but the review also found that the rate was the same for patients taking narcotic painkillers as for those taking Advil or Aleve.
The Times noted that two physicians at Yale University Medical School, Dr. William C. Becker and Dr. Patrick G. O’Connor, wrote in a commentary accompanying the study that the study’s findings could be skewed by undocumented patient use of over-the-counter painkillers. But they added that the high incidence of bone fractures, which often lead to fatal complications in the elderly, was troublesome.
