Receipt of prescription opioid medication is associated with increased mortality in an Israeli population – a cohort study.

Abstract

Abstract Background - Despite Israel’s increased use of prescription opioids, reported deaths resulting or associated with opioids have decreased, in fact dramatically, since 2005. This contrast is unique and difficult to explain. Methods – A historical cohort analysis of Clalit Health Services (CHS) data including all adult patients prescribed opiates between 2010 and 2020, excluding patients with oncologic diagnoses. Patients were classified into three groups according to opioid use: below 50 Morphine milligram equivalents (MME) per day, 50 to 90 MME per day, and above 90 MME per day. Sex, Charlson comorbidity score, age and socioeconomic status were recorded. Mortality rates were compared between the dosage groups and additionally, age-standardized mortality rates were compare the general population mortality rates. Results - On multivariate analysis, patients receiving 90 or more MME per day were 2.4 (95%CI 2.1 to 2.7) more likely to have died compared to patients receiving below 50 MME per day. The respective hazard ratio among patients receiving between 50 and 90 MME per day was 2.2 (2.0 to 2.5). Among patients aged 18 to 50, standardized mortality ratios compared to the general population ranged between 5.4 (5.3–6.6) to 8.6 (7.8–9.7) among women, receiving between 50 and 90 MME per day, and between 8.1 (7.3–9.2) and 10.6 (9.5–12.1) among women receiving 90 or more MME per day. The respective SMRs among men were 1.2 (1.1–1.3) to 3.8 (3.5–4.2) and 2.7 (2.4-3.0) to 5.4 (4.9–5.9). Conclusion – We demonstrate that increased opioid use is associated with increased mortality among non-oncological patients, while controlling for co-morbidities. We have shown this among young adults with little or no known comorbidities. These findings are consistent with results in other countries and seem more credible than previous Israeli reports.