The use of opioid analgesics is a standard practice worldwide for the management of both acute and chronic pain. These powerful drugs have transformed pain relief in clinical settings, providing comfort to those who suffer from debilitating conditions. However, alongside their benefits, opioids carry risks, such as the potential for addiction and serious adverse events—including respiratory depression and death. This double-edged nature of opioid analgesics necessitates a continuous assessment of their safety profiles.
In Japan, a developed country known for its advanced healthcare system and stringent drug safety regulations, opioid analgesics are prescribed with caution, possibly reflected in the lower prevalence of opioid abuse compared to countries like the United States. Nevertheless, the occurrence of serious adverse events remains a concern. A study published in the Biological & Pharmaceutical Bulletin, with the DOI 10.1248/bpb.b18-00997, has provided a crucial evaluation of the current status of adverse events associated with opioid analgesics in Japan, focusing on temporal changes and the incidence of opioid-related deaths.
The study leverages the Japanese Adverse Drug Event Report (JADER) database, a national repository of adverse drug event reports, to observe trends from 2004 to 2017. Across this period, the researchers, including Yukio Suga and colleagues from various prestigious institutions in Japan, delved into several aspects of opioid-related adverse events. Firstly, they monitored changes in the number and proportion of these reports over time. Additionally, they scrutinized the trends related to specific opioids like morphine, oxycodone, and fentanyl, correlating them to annual consumption rates. Finally, they reviewed cases where opioid-related adverse events had fatal outcomes.
The findings of the investigation indicated relatively stable occurrences of opioid-related adverse events overall, despite fluctuations in opioid consumption and proportions used of each opioid type within the evaluated timeframe. However, the statistics on fentanyl stood out. Since 2010, both the number and rate of fentanyl-related adverse events, as well as deaths resulting from such events, began to rise. Strikingly, these figures for fentanyl surpassed those of morphine and oxycodone. Most deaths linked to fentanyl were attributed to respiratory depression, a severe and life-threatening condition.
The study’s results imply that while medical professionals in Japan can control opioid-related adverse events through diligent monitoring and management, heightened vigilance is particularly crucial for fentanyl, a synthetic opioid known for its potent analgesic properties and increased potential for harm. The detailed assessment, as presented in the publication, serves as a valuable resource for healthcare practitioners, policymakers, and researchers, contributing to the safer use of opioid medications while maintaining their therapeutic benefits.
Considering the gravity and relevance of this study, several references relevant to the topic can be offered for further reading:
1. Pergolizzi, J. V., Ma, L., Foster, D. R., Overholser, B. R., Sowinski, K. M., Taylor, R., … & Zaveri, N. T. (2008). Opioid-induced respiratory depression: Molecular mechanisms and clinical implications. American Journal of Health-System Pharmacy, 65(9), 828-836. DOI: 10.2146/ajhp070181
2. Ray, W. A., Chung, C. P., Murray, K. T., Hall, K., & Stein, C. M. (2012). Prescription of long-acting opioids and mortality in patients with chronic noncancer pain. JAMA, 315(22), 2415-2423. DOI: 10.1001/jama.2016.7789
3. Manchikanti, L., Helm II, S., Fellows, B., Janata, J. W., Pampati, V., Grider, J. S., & Boswell, M. V. (2012). Opioid epidemic in the United States. Pain Physician, 15(3 Suppl), ES9-ES38.
4. Dahan, A., Aarts, L., & Smith, T. W. (2010). Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology, 112(1), 226-238. DOI: 10.1097/ALN.0b013e3181c38c25
5. Yokell, M. A., Delgado, M. K., Zaller, N. D., Wang, N. E., McGowan, S. K., & Green, T. C. (2014). Presentation of prescription and nonprescription opioid overdoses to US emergency departments. JAMA Internal Medicine, 174(12), 2034-2037. DOI: 10.1001/jamainternmed.2014.5413
Keywords
1. Opioid-related adverse events Japan
2. Fentanyl respiratory depression
3. JADER database opioid
4. Opioid analgesic safety
5. Morphine oxycodone adverse outcomes