A new study published in the journal Drug Safety points to a direct correlation between the potency of an opioid analgesic and the rate of serious adverse events (SAEs).
For this study, researchers investigated the rate of SAEs among commonly prescribed opioids of different potencies using the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program. SAEs were defined as death, major medical effect, or hospitalization due to opioid exposure. The 7 opioids included for analysis were oxycodone, hydrocodone, morphine, hydromorphone, oxymorphone, tapentadol, and tramadol.
Over the 7-year study period (2010–2016), a total of 19,480 cases of SAEs were identified. The majority of SAE cases (77%) were due to hydrocodone and oxycodone. Based on potency levels, the highest SAE rates were seen with hydromorphone (8.02 SAEs/100kg) whereas the lowest rates were seen with tapentadol (0.27 SAEs/100kg); this translated to a 30-fold difference among individual opioid analgesics.
A significant and positive linear relationship was observed between potency and SAE rate. “SAEs increased 2.04 per 100kg drug dispensed for each 1-unit rise in MME [morphine milligram equivalents],” the authors noted. “Linear regression of SAE/100kg drug dispensed and drug potency identified that MME comprised 96% of the variation observed.”
However, potency did not explain the variations seen with other study factors such as prescriptions dispensed, dosage units dispensed, and the number of patients filling a prescription.
Based on the findings, the authors concluded that opioid potency “should be carefully considered from both individual provider and public health perspectives.”
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