‘Deeply alarming’: Opioid deaths with GI issues

Key takeaways:

• Opioid-related deaths with GI complications increased by 218.6% between 2010 and 2020.
• Men and people living in West Virginia, Ohio and Maryland appeared to be disproportionately affected.

The number of opioid-related deaths with concurrent gastrointestinal complications in the United States more than tripled from 2010 to 2020, with men and individuals living in the Appalachian region disproportionately affected.

The data, published in Cureus, highlight the importance of not just looking at overdose deaths and incidence, but also factoring in other long-term medical complications as a result of long-term opioid use, according to researchers.

“While we expected to see some increase given the overall trajectory of the opioid crisis, the sheer magnitude of the escalation was truly staggering,” John K. Appiah, MD, an internal medicine resident at Geisinger Wyoming Valley, told Healio.

“What really struck us was that this wasn’t just a gradual increase — this was an exponential rise that outpaced even our most concerning projections,” he added. “We’re talking about an additional 48,000 deaths in 2020 compared to 2010, deaths that involved both opioid use and serious gastrointestinal complications. The consistency and persistence of this upward trend throughout the entire study period was both unexpected and deeply alarming from a public health perspective.”

Examining ‘hidden impacts’

The opioid epidemic within the United States has been one of the country’s most troublesome public health emergencies in history, with more than 500,000 drug overdose deaths reported since 1999, according to study background.

Much emphasis has been placed on acute overdose mortality; however, a far less examined aspect of the opioid crisis includes complex medical complications that arise due to opioid use.

“Our research team has been deeply concerned about the hidden impacts of the opioid crisis, particularly how long-term opioid use damages organ systems beyond what we typically hear about in overdose cases,” Appiah told Healio. “In our clinical practice, we started seeing more and more patients with opioid use disorders who were also suffering from serious gastrointestinal complications like severe constipation, intestinal blockages and bleeding.

“These weren’t isolated cases, so we wondered: Is this pattern happening nationwide?” he added. “And more importantly, could these gastrointestinal complications be contributing to the rising death toll in ways we haven’t fully recognized?”

Appiah and colleagues conducted a retrospective, population-based analysis to characterize trends in opioid-related deaths with concurrent GI complications in the United States from 2010 to 2020.

The researchers used mortality data from CDC’s Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database and the Global Burden of Disease study 2021.

‘Increased integration’ of care needed

Results showed that opioid-related deaths with GI complications increased by 218.6%, from 22,040 deaths in 2010 to 70,222 in 2020 (7.15 per 100,000 vs. 21.31 per 100,000).

Men appeared to have disproportionately higher mortality rates compared with women (16.31 per 100,000 vs. 7.76 per 100,000).

States with the highest crude mortality rates included West Virginia (37.85 per 100,000), Ohio (23.48 per 100,000) and Maryland (23.19 per 100,000).

Ohio had the highest total number of opioid-related deaths with GI complications (n = 29,994) between 2010 and 2020, with California (n = 28,399) and Florida (n = 28,237) close behind.

The researchers noted a gradual increase in deaths from 2010 to 2014, with a marked increase from 2015 to 2017 and a “dramatic surge” in 2020, aligning with the opioid epidemic.

These findings underscore the importance of addiction treatment and management of medical comorbidities, as well as targeted interventions and overdose prevention strategies in areas with the highest burden, according to the researchers.

In addition, patients on long-term opioid therapy should be monitored for GI complications and receive preventive care, Appiah said.

“We can’t just focus on pain management and addiction risk,” he added.

“The broader message is that opioid-related mortality is more medically complex than we’ve been treating it,” Appiah told Healio. “These aren’t just overdose deaths. They’re often deaths involving multiple organ systems that could potentially be prevented with better clinical care.”

Appiah also emphasized the need for prospective studies following patients on opioid therapy to better understand the development of GI complications and who is most at risk. Specific interventions, such as standardized bowel regimens, that may reduce these complications should also be studied, he said.

“As we continue to battle the opioid epidemic, understanding and addressing the full range of medical complications — not just overdose — will be essential,” Appiah told Healio. “This study calls for increased integration between addiction medicine, gastroenterology and primary care in managing these high-risk patients. We’re essentially treating these patients in silos when these complications don’t respect medical specialties and need integrated, proactive management.

“If we’re only looking at direct overdoses, we’re missing a substantial portion of the mortality burden,” he added. “That has implications for funding, resource allocation and policy responses to this crisis.”