New initiation of opioid therapy in older adults with chronic obstructive pulmonary disease (COPD) was associated with an increased risk of coronary artery disease-related death when compared to non-opioid users, according to a study published in the European Journal of Clinical Pharmacology.

Earlier literature had indicated an increased risk of death from respiratory complications among patients with COPD who were recently started on opioid vs. non-users. 

Through various provincial healthcare administrative databases within the Institute for Clinical Evaluative Sciences (ICES), researchers from St. Michael’s Hospital evaluated medical records of 134,408 community-dwelling adults and 14,685 long-term care adults in Ontario aged ≥66 years with COPD. Of the total patients, 60% of community-dwelling adults and 67% of long-term care adults were started on a new opioid between April 2008 and March 2013; prescribed opioids included morphine and fentanyl. The study authors focused on opioids that were not combined with aspirin or tylenol. 

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Morphine and fentanyl are commonly prescribed among older adults with COPD to relieve chronic musculoskeletal pain, insomnia, persistent cough and shortness of breath despite inhaler use. 

The study found a 215% increase in coronary artery disease-related death for long-term care patients and an 83% increase in patients who lived at home newly started on opioids vs. non-opioid users. Opioids, which lower oxygen and raise carbon dioxide levels in the blood, can negatively impact the heart. These drugs also increase inflammatory factors in the blood vessels, which can lead to blockages and cause a heart attack. 

Lead author, Dr. Nicholas Vozoris, stated, “Our new findings show there are not only increased risks for coronary artery disease-related death associated with new opioid use, but also increased risk of cardiac-related visits to emergency rooms and hospitalizations.” He also pointed out that the pain relief provided by opioids can minimize or reduce the chest pain that “acts as a warning before a cardiac event.” 

The study authors encourage healthcare providers to be cautious in prescribing opioids to patients with COPD and to monitor potential adverse events. 

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