Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain

Erin E. Krebs, William C. Becker, Judy Zerzan, Matthew Bair, Kimberly McCoy, Siu Hui

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Data on comparative safety of opioid analgesics are limited, but some reports suggest disproportionate mortality risk associated with methadone. Our objective was to compare mortality rates among patients who received prescribed methadone or long-acting morphine for pain. This is a retrospective observational cohort drawn from Department of Veterans Affairs (VA) health care databases, January 1, 2000, to December 31, 2007. We included 28,554 patients who received methadone and 79,938 who received long-acting morphine from VA pharmacies. Compared with those who received long-acting morphine, patients who received methadone were younger, less likely to have some medical comorbidities, and more likely to have psychiatric and substance use disorders. Patients were stratified into quintiles according to propensity score; the probability of receiving methadone was conditional on demographic, clinical, and VA service area variables. Overall propensity-adjusted mortality was lower for methadone than for morphine. Hazard ratios varied across propensity score quintiles; the magnitude of the between-drug difference in mortality decreased as the propensity to receive methadone increased. Mortality was significantly lower for methadone in all but the last quintile, in which there was no between-drug difference in mortality (hazard ratio = 0.92, 95% confidence interval = 0.74, 1.16). Multiple sensitivity analyses found either no difference in mortality between methadone and long-acting morphine or lower mortality rates among patients who received methadone. In summary, we found no evidence of excess all-cause mortality among VA patients who received methadone compared with those who received long-acting morphine. Randomized trials and prospective observational research are needed to better understand the relative safety of long-acting opioids. Among patients who received methadone or long-acting morphine for pain from Department of Veterans Affairs pharmacies in 2000-2007, no evidence of excess all-cause mortality associated with methadone was found.

Original languageEnglish
Pages (from-to)1789-1795
Number of pages7
JournalPain
Volume152
Issue number8
DOIs
StatePublished - Aug 2011

Fingerprint

Methadone
Veterans
Chronic Pain
Morphine
Mortality
Propensity Score
Pharmacies
Opioid Analgesics
Veterans Health
Safety
Pain
Pharmaceutical Preparations
Substance-Related Disorders
Psychiatry
Comorbidity
Demography

Keywords

  • Methadone
  • Morphine
  • Mortality
  • Opioid analgesics

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Neurology
  • Pharmacology

Cite this

Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain. / Krebs, Erin E.; Becker, William C.; Zerzan, Judy; Bair, Matthew; McCoy, Kimberly; Hui, Siu.

In: Pain, Vol. 152, No. 8, 08.2011, p. 1789-1795.

Research output: Contribution to journalArticle

Krebs, Erin E. ; Becker, William C. ; Zerzan, Judy ; Bair, Matthew ; McCoy, Kimberly ; Hui, Siu. / Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain. In: Pain. 2011 ; Vol. 152, No. 8. pp. 1789-1795.
@article{45edf374b9344924bcb9ae5db21ab277,
title = "Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain",
abstract = "Data on comparative safety of opioid analgesics are limited, but some reports suggest disproportionate mortality risk associated with methadone. Our objective was to compare mortality rates among patients who received prescribed methadone or long-acting morphine for pain. This is a retrospective observational cohort drawn from Department of Veterans Affairs (VA) health care databases, January 1, 2000, to December 31, 2007. We included 28,554 patients who received methadone and 79,938 who received long-acting morphine from VA pharmacies. Compared with those who received long-acting morphine, patients who received methadone were younger, less likely to have some medical comorbidities, and more likely to have psychiatric and substance use disorders. Patients were stratified into quintiles according to propensity score; the probability of receiving methadone was conditional on demographic, clinical, and VA service area variables. Overall propensity-adjusted mortality was lower for methadone than for morphine. Hazard ratios varied across propensity score quintiles; the magnitude of the between-drug difference in mortality decreased as the propensity to receive methadone increased. Mortality was significantly lower for methadone in all but the last quintile, in which there was no between-drug difference in mortality (hazard ratio = 0.92, 95{\%} confidence interval = 0.74, 1.16). Multiple sensitivity analyses found either no difference in mortality between methadone and long-acting morphine or lower mortality rates among patients who received methadone. In summary, we found no evidence of excess all-cause mortality among VA patients who received methadone compared with those who received long-acting morphine. Randomized trials and prospective observational research are needed to better understand the relative safety of long-acting opioids. Among patients who received methadone or long-acting morphine for pain from Department of Veterans Affairs pharmacies in 2000-2007, no evidence of excess all-cause mortality associated with methadone was found.",
keywords = "Methadone, Morphine, Mortality, Opioid analgesics",
author = "Krebs, {Erin E.} and Becker, {William C.} and Judy Zerzan and Matthew Bair and Kimberly McCoy and Siu Hui",
year = "2011",
month = "8",
doi = "10.1016/j.pain.2011.03.023",
language = "English",
volume = "152",
pages = "1789--1795",
journal = "Pain",
issn = "0304-3959",
publisher = "Elsevier",
number = "8",

}

TY - JOUR

T1 - Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain

AU - Krebs, Erin E.

AU - Becker, William C.

AU - Zerzan, Judy

AU - Bair, Matthew

AU - McCoy, Kimberly

AU - Hui, Siu

PY - 2011/8

Y1 - 2011/8

N2 - Data on comparative safety of opioid analgesics are limited, but some reports suggest disproportionate mortality risk associated with methadone. Our objective was to compare mortality rates among patients who received prescribed methadone or long-acting morphine for pain. This is a retrospective observational cohort drawn from Department of Veterans Affairs (VA) health care databases, January 1, 2000, to December 31, 2007. We included 28,554 patients who received methadone and 79,938 who received long-acting morphine from VA pharmacies. Compared with those who received long-acting morphine, patients who received methadone were younger, less likely to have some medical comorbidities, and more likely to have psychiatric and substance use disorders. Patients were stratified into quintiles according to propensity score; the probability of receiving methadone was conditional on demographic, clinical, and VA service area variables. Overall propensity-adjusted mortality was lower for methadone than for morphine. Hazard ratios varied across propensity score quintiles; the magnitude of the between-drug difference in mortality decreased as the propensity to receive methadone increased. Mortality was significantly lower for methadone in all but the last quintile, in which there was no between-drug difference in mortality (hazard ratio = 0.92, 95% confidence interval = 0.74, 1.16). Multiple sensitivity analyses found either no difference in mortality between methadone and long-acting morphine or lower mortality rates among patients who received methadone. In summary, we found no evidence of excess all-cause mortality among VA patients who received methadone compared with those who received long-acting morphine. Randomized trials and prospective observational research are needed to better understand the relative safety of long-acting opioids. Among patients who received methadone or long-acting morphine for pain from Department of Veterans Affairs pharmacies in 2000-2007, no evidence of excess all-cause mortality associated with methadone was found.

AB - Data on comparative safety of opioid analgesics are limited, but some reports suggest disproportionate mortality risk associated with methadone. Our objective was to compare mortality rates among patients who received prescribed methadone or long-acting morphine for pain. This is a retrospective observational cohort drawn from Department of Veterans Affairs (VA) health care databases, January 1, 2000, to December 31, 2007. We included 28,554 patients who received methadone and 79,938 who received long-acting morphine from VA pharmacies. Compared with those who received long-acting morphine, patients who received methadone were younger, less likely to have some medical comorbidities, and more likely to have psychiatric and substance use disorders. Patients were stratified into quintiles according to propensity score; the probability of receiving methadone was conditional on demographic, clinical, and VA service area variables. Overall propensity-adjusted mortality was lower for methadone than for morphine. Hazard ratios varied across propensity score quintiles; the magnitude of the between-drug difference in mortality decreased as the propensity to receive methadone increased. Mortality was significantly lower for methadone in all but the last quintile, in which there was no between-drug difference in mortality (hazard ratio = 0.92, 95% confidence interval = 0.74, 1.16). Multiple sensitivity analyses found either no difference in mortality between methadone and long-acting morphine or lower mortality rates among patients who received methadone. In summary, we found no evidence of excess all-cause mortality among VA patients who received methadone compared with those who received long-acting morphine. Randomized trials and prospective observational research are needed to better understand the relative safety of long-acting opioids. Among patients who received methadone or long-acting morphine for pain from Department of Veterans Affairs pharmacies in 2000-2007, no evidence of excess all-cause mortality associated with methadone was found.

KW - Methadone

KW - Morphine

KW - Mortality

KW - Opioid analgesics

UR - http://www.scopus.com/inward/record.url?scp=79960440685&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960440685&partnerID=8YFLogxK

U2 - 10.1016/j.pain.2011.03.023

DO - 10.1016/j.pain.2011.03.023

M3 - Article

VL - 152

SP - 1789

EP - 1795

JO - Pain

JF - Pain

SN - 0304-3959

IS - 8

ER -