European Journal of Clinical Pharmacology

, Volume 73, Issue 10, pp 1287–1295 | Cite as

Adverse cardiac events associated with incident opioid drug use among older adults with COPD

  • Nicholas T. Vozoris
  • Xuesong Wang
  • Peter C. Austin
  • Douglas S. Lee
  • Anne L. Stephenson
  • Denis E. O’Donnell
  • Sudeep S. Gill
  • Paula A. Rochon
Pharmacoepidemiology and Prescription



We evaluated whether incident opioid drug use was associated with adverse cardiac events among older adults with chronic obstructive pulmonary disease (COPD).


This was an exploratory, retrospective cohort study using health administrative data from Ontario, Canada, from 2008 to 2013. Using a validated algorithm, we identified adults aged 66 years and older with non-palliative COPD. Hazard ratios (HR) were estimated for adverse cardiac events within 30 days of incident opioid receipt compared to controls using inverse probability of treatment weighting using the propensity score.


There were 134,408 community-dwelling individuals and 14,685 long-term care residents with COPD identified, 67.0 and 60.6% of whom received an incident opioid. Incident use of any opioid was associated with significantly decreased rates of emergency room (ER) visits and hospitalizations for congestive heart failure (CHF) among community-dwelling older adults (HR 0.84; 95% CI 0.73–0.97), but significantly increased rates of ischemic heart disease (IHD)-related mortality among long-term care residents (HR 2.15; 95% CI 1.50–3.09). In the community-dwelling group, users of more potent opioid-only agents without aspirin or acetaminophen combined had significantly increased rates of ER visits and hospitalizations for IHD (HR 1.38; 95% CI 1.08–1.77) and IHD-related mortality (HR 1.83; 95% CI 1.32–2.53).


New opioid use was associated with elevated rates of IHD-related morbidity and mortality among older adults with COPD. Adverse cardiac events may need to be considered when administering new opioids to older adults with COPD, but further studies are required to establish if the observed associations are causal or related to residual confounding.


Opioids COPD Cardiac Pharmacoepidemiology Drug safety 


Authors’ contributions

NTV, XW, PAC, DSL, ALS, DEO, SSG and PAR contributed substantially to the study design, data analysis and interpretation and the writing of the manuscript.

Compliance with ethical standards

This study was approved by the review ethics board at Sunnybrook Health Sciences Centre.

Conflicts of interest

All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare the following: NTV had support from Godfrey S. Pettit Respirology Block Term Grant for the submitted work; XW, PAC, DSL, ALS, DEO, SSG and PAR had no support from any organization for the submitted work; DEO received grants and personal fees from Boehringer Ingelheim, grants and personal fees from Astra Zeneca, grants from GlaxoSmithKline and personal fees from Novartis, in the previous 3 years; NTV, XW, PAC, DSL, ALS, DEO, SSG and PAR had no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and NTV, XW, PAC, DSL, ALS, DEO, SSG and PAR had no other relationships or activities that could appear to have influenced the submitted work.


This research was funded by a Godfrey S. Pettit Respirology Block Term Grant. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. We thank Brogan Inc., Ottawa for use of their Drug Information Database. P.C. Austin was supported in part by a Career Investigator Award from the Heart and Stroke Foundation. D.S. Lee was supported by a mid-career investigator award from the Heart and Stroke Foundation and is the Ted Rogers Chair in Heart Function Outcomes.

Supplementary material

228_2017_2278_MOESM1_ESM.doc (649 kb)
ESM 1 (DOC 649 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Nicholas T. Vozoris
    • 1
    • 2
    • 3
  • Xuesong Wang
    • 4
  • Peter C. Austin
    • 4
    • 5
  • Douglas S. Lee
    • 3
    • 4
    • 5
  • Anne L. Stephenson
    • 1
    • 2
    • 3
    • 5
  • Denis E. O’Donnell
    • 6
  • Sudeep S. Gill
    • 4
    • 6
  • Paula A. Rochon
    • 3
    • 4
    • 5
    • 7
  1. 1.Division of Respirology, Department of MedicineSt. Michael’s HospitalTorontoCanada
  2. 2.Keenan Research Centre in the Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  3. 3.Department of MedicineUniversity of TorontoTorontoCanada
  4. 4.Institute for Clinical Evaluative SciencesTorontoCanada
  5. 5.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  6. 6.Department of MedicineQueen’s UniversityKingstonCanada
  7. 7.Women’s College Research InstituteWomen’s College HospitalTorontoCanada

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