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Risk factors for opioid toxicity requiring naloxone rescue in adults: a case-control study

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Abstract

Background

Opioid-induced sedation and respiratory depression (OSRD) is a potentially life-threatening side effect of opioid analgesia. However, little is known about the individual and clinical-related factors associated with OSRD in the New Zealand context.

Aim

To identify risk factors for OSRD in patients admitted to a large regional health board in New Zealand—Auckland District Health Board (ADHB).

Method

A retrospective matched case-control study design was undertaken among adults who were admitted to ADHB and prescribed opioids in hospital between August 2015 and April 2020. Those who were prescribed opioids and received naloxone for OSRD were defined as cases, whereas those who received opioids but did not experience OSRD were identified as controls. Cases and controls were matched on a 1:1 basis by age (± 10 years). Data were retrieved from the electronic medical records of ADHB. A conditional logistic regression model was used to identify the risk factors for OSRD.

Results

We identified 51 cases, and these were matched with 51 control patients. The odds of experiencing OSRD were four times higher among opioid-naïve patients compared to those exposed to opioids prior to hospital admission (OR  4.113; 95% CI 1.14–14.89). Increased risk of OSRD was also associated with higher serum creatinine level prior to OSRD episode (OR 1.015; 95% CI 1.01–1.03) and a higher oral morphine milligram equivalent (OME) (OR 1.023; 95% CI 1.01–1.04).

Conclusion

Increased risk of OSRD was associated with a higher OME, a higher serum creatinine level prior to OSRD episode, and opioid naivety. Our findings can inform policies that aim to prevent serious adverse effects related to opioids.

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Acknowledgements

We would like to thank Auckland District Health Board for providing access to electronic medical records and their Business Intelligence Unit for support with data provision.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pharmaceutical and Administrative Sciences, St Louis College of Pharmacy, University of Health Sciences and Pharmacy, 1 Pharmacy Place, St. Louis, MO, 63110, USA

    Kebede Beyene

  2. Pharmacy Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand

    Wilson Shen

  3. Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand

    Terry Mitchell

  4. School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

    Scott Gilson, Stella Kang, Daniel Lai, Liandra Misquitta, Atifa Slaimankhel & Amy Hai Yan Chan

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  1. Kebede Beyene
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Correspondence to Kebede Beyene.

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Conflicts of interest

KB reports grants from Health Research Council of New Zealand, Amgen, A + Charitable Trust (Auckland District Health Board), Universitas 21, New Zealand Pharmacy Education and Research Foundation, the University of Auckland, and Addis Ababa University outside this work. AC is a fellow and supported by Asthma UK as part of the Asthma UK Centre for Applied Research (Grant Nos. AUK-AC-2012-01 and AUK-AC-2018-01). AC reports grants from Innovate UK, A + CharitableTrust (Auckland District Health Board), Maurice and Phyllis Paykel Trust, Universitas 21, New Zealand Pharmacy Education Research Fund, Auckland Academic Health Alliance, AsthmaUK, Health Research Council, Chorus Ltd, Oakley Mental Health Foundation and the University of Auckland; reports consultancy fees from Janssen-Cilag and UCL-Business spin-out company Spoonful of Sugar Ltd; and is the recipient of the Robert Irwin Postdoctoral Fellowship, outside the submitted work. All other authors report no conflict of interest.

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The original online version of this article was revised: The heading size of “Aim” and “Ethics approval” are corrected. “Methods’ changed to “Method”. “Conflict of interest” changed to “Conflicts of interest”. In reference 22 and 33 is updated with et al. after three authors.

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Beyene, K., Shen, W., Mitchell, T. et al. Risk factors for opioid toxicity requiring naloxone rescue in adults: a case-control study. Int J Clin Pharm 44, 1296–1303 (2022). https://doi.org/10.1007/s11096-022-01460-1

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