The known harms of opioid addiction and overdose may be just the beginning of opioids’ known risks. New research published in the Journal of Pain on November 27 suggests prescribed opioids also may have cardiovascular consequences.“Beyond the harms of opioids that we are more aware of, there are others we are still uncovering,” says Minhee Sung, MD, instructor of medicine (general medicine & addiction medicine) and first author of the study. Clinicians sometimes prescribe opioids to treat moderate-to-severe pain, including for chronic pain—which is a condition affecting over 50 million Americans. It is especially prevalent among those 65 and older—impacting as much as 60 to 75% of this population. “Chronic pain is one of the most common conditions that older adults experience,” says Sung. The large number of patients who might be prescribed opioids focuses added concerns about their use, especially in a population that is at increased risk for heart issues. Opioid use may increase cardiovascular disease riskBuilding on a line of work to understand prescribed opioid-related harms, in their latest study, this team led by Sung analyzed data from the Veterans Aging Cohort Study (VACS). They focused on approximately 50,000 patients, 30% of whom had received prescribed opioids, over a three-year period. Those who had received prescribed opioids were significantly more likely to later develop cardiovascular disease (CVD), the researchers found. The researchers also found that higher doses were associated with a higher risk of CVD. “This is highly relevant for a huge number of the American population as so many patients are of older age, experience chronic pain, have taken opioids, or are already at risk for cardiovascular disease,” says Sung. We are interested in learning more about how taking prescribed opioids over time impacts risk of cardiovascular disease and learning more about the mechanisms driving these risks.E. Jennifer Edelman, MDThe study’s cohort included patients receiving prescribed opioids for both short- [less than 90 days] and long-term [90 days or more] durations, ranging from three to 23 days for most patients. In future studies, “we are interested in learning more about how taking prescribed opioids over time impacts risk of cardiovascular disease and learning more about the mechanisms driving these risks,” says E. Jennifer Edelman, MD, professor of medicine (general medicine) and the study’s senior author. “More work is needed to understand whether it is related to the prescribed opioids themselves or exposures that often co-occur with prescribed opioids.”Cardiovascular disease risk should be considered in chronic pain treatmentAs awareness of the dangers of opioids grows, clinicians should use caution when treating patients with chronic pain, says Sung. However, they should also consider the risks of abruptly discontinuing the drugs, especially given the limited availability of other effective pain management options. “In response to the opioid epidemic and increased scrutiny about opioid prescriptions, many clinicians have suddenly stopped prescribing opioids for people who have depended on them for a long time or seriously suffer with chronic pain without offering alternative solutions to treat their pain,” she says. Research shows that this sudden cessation can cause significant psychological stress and increased risk of suicide. Sung advises patients who are older than 65, have diabetes, or have other risk factors for cardiovascular disease to have conversations with their provider about their pain management plan. “If you are already at greater risk for cardiovascular disease, talk to your doctor about other ways to treat your pain,” she says. Options include non-pharmacologic treatments for pain such as physical therapy and cognitive behavioral therapy for chronic pain.