National Frequencies of Administering or Prescribing Immunosuppressive Opioids in US Ambulatory Care Settings: 2006–2016

Abstract

Background: Several decades of animal and basic science research have demonstrated that certain opioids have immunosuppressive properties, but the clinical relevance of opioid-related immunosuppression remains unclear. Although experts have called for epidemiologic research to inform clinical practice, prioritization of that research depends partly on a determination of the number of people potentially affected. To date, population-level estimates of administering or prescribing immunosuppressive opioids (ISOs) have not been measured. Our objective was to estimate the overall frequency of ambulatory visits involving ISOs, and to estimate the frequency of these visits among immunocompromised patients. Methods: We used the CDC National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey–Emergency Departments (NHAMCS-ED) data sets (2006–2016) to compute average annual frequencies of patient visits involving ISOs. We accounted for survey sampling design and visit weights using SAS version 9.4 software. We adopted a definition of ISOs from the literature as ‘alone or in-combination’ formulas of codeine, morphine, and fentanyl. We approximated patients’ immunocompromised status by the administering or prescribing of anti-infective drugs, and by chronic conditions indicative of immunocompromised status. We stratified visits with mentions of ISOs by co-occurring clinical-use of anti-infective drugs, and by selected chronic conditions. Results: From 2006 to 2016, annual averages of 7.9% (N = 10,383,000; SE, 447,000) of all ED visits and 1.3% (N = 12,674,000; SE, 558,000) of all outpatient office visits involved the administering or prescribing of 1 or more ISO. Over the same period, coprescribing or administering of anti-infective drugs alongside ISOs occurred during 2.1% (N = 2,782,000; SE, 130,000) of all ED visits, and 0.4% (N = 3,525,000; SE, 219,000) of all outpatient office visits. ED visits by patients with selected chronic conditions who were administered or prescribed ISOs include cancer—499,000 (SE, 39,000), diabetes—1,369,000 (SE, 82,000), and HIV—45,000 (SE, 7,000). Outpatient office visits by patients with selected chronic conditions who were administered or prescribed ISOs include cancer—1,032,000 (SE, 92,000), diabetes—1,802,000 (SE, 142,000), and chronic renal failure—138,000 (SE, 22,000). Conclusions: More than 10 million ED visits and 12 million outpatient office visits involved the clinical use of ISOs on average, from 2006 to 2016. These averages include visits by immunocompromised patients who could potentially benefit from nonimmunosuppressive analgesic alternatives, when appropriate. Until further research is conducted on the clinical relevance of these opioids’ immunosuppressive properties, their use to treat immunocompromised patients may represent unrecognized patterns of inappropriate drug use.

Funding: None

Disclosures: None