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Opioid

Hayley C Gorton, Roger T Webb, Mathew J Carr, Marcos Delpozo-Banos, Ann John, Darren M Ashcroft

Type
Drug
ID
PH471
Version ID
942
Data Sources
Valid event data range
01/01/1998 - 31/03/2014
Sex
Female, Male
Agreement Date
2018-04-09
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Importance:

People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported.

Objective:

To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths.

Design, Setting, and Participants:

This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014). Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017.

Exposures:

People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions.

Main Outcomes and Measures:

Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths.

Results:

In total, 44678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort. Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy.

Conclusions and Relevance:

Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.

Publications

  • Hayley C Gorton, Roger T Webb, Mathew J Carr, Marcos Delpozo-Banos, Ann John, Darren M Ashcroft, Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurology, 75(8), 929-038, 2018.

Clinical Code List

Rows: 89
Code Description Entity type Category Coding System (Read)
a81.. codeine phosphate [git] res55: opioid drug Read
a811. codeine phosphate 15mg tablets res55: opioid drug Read
a812. codeine phosphate 30mg tablets res55: opioid drug Read
a813. codeine phosphate 60mg tablets res55: opioid drug Read
dia1. *aspirin/paracet/codeine tabs res55: opioid drug Read
dia2. co-codamol 8mg/500mg tablets res55: opioid drug Read
dia3. co-codamol 8mg/500mg disp tabs res55: opioid drug Read
dia6. co-dydramol tablets res55: opioid drug Read
dia7. *co-proxamol tablets res55: opioid drug Read
diaI. *paracet+codeine 500/30mg/sach res55: opioid drug Read
diaJ. *kapake insts 500mg/30mg/sach res55: opioid drug Read
diaL. *kapake insts 1000mg/60mg pdr res55: opioid drug Read
diaT. codipar caplets res55: opioid drug Read
diaU. paracet+codeine 500/15mg tabs res55: opioid drug Read
diam. kapake tablets res55: opioid drug Read
dian. paracet+codeine 500/30mg tabs res55: opioid drug Read
diao. kapake capsules res55: opioid drug Read
diap. co-codamol 8mg/500mg eff tabs res55: opioid drug Read
diaq. co-codamol 8mg/500mg capsules res55: opioid drug Read
dib3. *medocodeine tablets res55: opioid drug Read
dibD. paracet+codeine 500/30mg caps res55: opioid drug Read
dibG. tylex effervescent sol.tabs res55: opioid drug Read
dibJ. *remedeine forte eff tabs res55: opioid drug Read
dibK. *remedeine eff tabs res55: opioid drug Read
dibR. solpadeine max tablets res55: opioid drug Read
dibS. solpadol capsules res55: opioid drug Read
dibn. solpadeine soluble eff tabs res55: opioid drug Read
dibo. *solpadeine forte disp tabs res55: opioid drug Read
dibt. tylex 500mg capsules res55: opioid drug Read
dibu. solpadol effervescent tablets res55: opioid drug Read
dibv. remedeine tablets res55: opioid drug Read
dibw. remedeine forte tablets res55: opioid drug Read
dibz. solpadol caplets res55: opioid drug Read
dic3. zapain caplets res55: opioid drug Read
dic4. zapain capsules res55: opioid drug Read
dicJ. solpadeine headache tablets res55: opioid drug Read
dicK. solpadeine headache sol tabs res55: opioid drug Read
dicN. *kapake 30/500 eff tablets res55: opioid drug Read
dicO. tramacet 325mg/37.5mg tablets res55: opioid drug Read
dicY. tramacet 325mg/37.5mg eff tabs res55: opioid drug Read
dica. codipar 15mg/500mg eff tabs res55: opioid drug Read
dj1.. morphine salts(1) [cns] res55: opioid drug Read
dj2.. morphine analgesic elixirs res55: opioid drug Read
dj3.. buprenorphine res55: opioid drug Read
dj4.. codeine phosphate [analgesic] res55: opioid drug Read
dj5.. dextromoramide res55: opioid drug Read
dj6.. dextropropoxyphene hcl res55: opioid drug Read
dj7.. diamorphine hcl [analgesic] res55: opioid drug Read
dj8.. dihydrocodeine tartrate res55: opioid drug Read
dj9.. dipipanone hydrochloride res55: opioid drug Read
djA.. tramadol (2) res55: opioid drug Read
djB.. tapentadol res55: opioid drug Read
dja.. *levorphanol tartrate [cns] res55: opioid drug Read
djb.. meptazinol [analgesic] res55: opioid drug Read
djc.. methadone hcl [analgesic] res55: opioid drug Read
djd.. nalbuphine hydrochlor [cns] res55: opioid drug Read
dje.. *papaveretum [cns narcotic] res55: opioid drug Read
djf.. pentazocine res55: opioid drug Read
djg.. pethidine hydrochlor [analg] res55: opioid drug Read
djh.. phenazocine hydrobromide res55: opioid drug Read
dji.. tramadol res55: opioid drug Read
djj.. hydromorphone hydrochloride res55: opioid drug Read
djk.. oxycodone hydrochloride res55: opioid drug Read
djm.. oxycodone hydrochloride (2) res55: opioid drug Read
djy.. morphine salts(3) [cns] res55: opioid drug Read
djz.. morphine salts(2) [cns] res55: opioid drug Read
dl11. migraleve duo-pack tablets res55: opioid drug Read
dl12. migraleve pink tablets res55: opioid drug Read
dl13. migraleve yellow tablets res55: opioid drug Read
dl14. *migravess dispersible tablets res55: opioid drug Read
dl15. *migravess forte tablets res55: opioid drug Read
dl18. migraleve duo-pack tablets x48 res55: opioid drug Read
dl19. migraleve pink tablets x48 res55: opioid drug Read
dl1a. *migraleve yellow tablets x48 res55: opioid drug Read
j28O. ibupro+codeine 200/12.5mg tabs res55: opioid drug Read
j28V. ibupro+codeine 200/12.8mg tabs res55: opioid drug Read
j28z. *ibupr+codein 300/20mg m/r tab res55: opioid drug Read
j2pT. solpadeine migraine ibu+cod res55: opioid drug Read
o41.. alfentanil res55: opioid drug Read
o42.. fentanyl res55: opioid drug Read
o44.. meptazinol [anaesthesia] res55: opioid drug Read
o45.. morphine salts [anaesthesia] res55: opioid drug Read
o46.. nalbuphine hydrochl [anaesth] res55: opioid drug Read
o47.. papaveretum [anaesthesia] res55: opioid drug Read
o48.. pethidine hydrochlor [anaesth] res55: opioid drug Read
o49.. phenoperidine hydrochloride res55: opioid drug Read
o4c.. remifentanil res55: opioid drug Read
o4d.. fentanyl (2) res55: opioid drug Read
o4e.. fentanyl (3) res55: opioid drug Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH471/version/942/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH471/version/942/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH471', '942', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH471/version/942/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH471/version/942/export/codes/?format=json
CSV site_root/phenotypes/PH471/version/942/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH471', '942', api_client=client)

Version History

Version
ID
Name Owner Publish date
942 Opioid ieuan.scanlon 2021-10-06 currently shown

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