Opioids For Pain Can Exacerbate Pneumococcal Infections

MedicalResearch.com Interview with:

Andrew Wiese, PhD Postdoctoral Research Fellow, Department of Health Policy Vanderbilt University Medical Center

Dr. Wiese

Andrew Wiese, PhD
Postdoctoral Research Fellow
Department of Health Policy
Vanderbilt University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As opioid use has increased in the U.S., the safety of prescription opioids has come under further scrutiny.

In animal studies, use of certain opioids has been associated with increased susceptibility to bacterial infections, including infectious due to Streptococcus pneumoniae, the pathogen that causes invasive pneumococcal disease. Invasive pneumococcal disease includes bacteremia, meningitis, and invasive pneumonia, all of which are associated with high mortality. Although those associations have been well established in animal experiments, it is important to understand the risk of serious infections among humans taking prescription opioid analgesics.

We found that prescription opioid use is associated with a significantly increased risk for laboratory-confirmed invasive pneumococcal diseases, and that this association was strongest for opioids used at high doses, those classified as high potency and long-acting formulations.

The data also showed that opioids previously described as immunosuppressive in prior experimental studies conducted in animals had the strongest association with invasive pneumococcal diseases in humans.

MedicalResearch.com: What should readers take away from your report?

Response: Providers should consider these findings when choosing whether to treat with opioid analgesics in the first place and also when considering the type of opioid formulation to prescribe, especially among individuals already at high-risk for infections, such as older adults.

Patients using opioid analgesics should also consider these findings, as an increased risk of serious infection should be an additional consideration on top of other known risks related to opioid use. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Because there are differences in the bioavailability, half-life, and amount of active metabolites among different opioids, we would expect that the association between opioid use and serious infections might vary across opioids. Future studies will be important to characterize the role of individual opioids and inform prescribers and patients regarding appropriate opioid selection.

No disclosures. 


Wiese AD, Griffin MR, Schaffner W, Stein CM, Greevy RA, Mitchel EF, et al. Opioid Analgesic Use and Risk for Invasive Pneumococcal DiseasesA Nested Case–Control Study. Ann Intern Med. [Epub ahead of print 13 February 2018] doi: 10.7326/M17-1907

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Last Updated on February 13, 2018 by Marie Benz MD FAAD