A LARGE study of the Danish population has revealed that cumulative opioid use for noncancer pain exceeding 90 total standardised doses (TSDs) is associated with an increased risk of dementia, particularly in younger age groups.
This nested case-control study utilised data from Danish national registers, focusing on 1,872,854 individuals without prior dementia, cancer, opioid addiction, or terminal illness-related opioid use. Within this cohort, 93,638 individuals (5.0%) developed all-cause dementia and were matched to 468,190 dementia-free controls. Opioid exposure was measured based on prescription records spanning 1995–2020. Conditional logistic regression assessed the risk of dementia, adjusting for various confounding factors. The findings demonstrated that opioid use below 90 TSDs was not significantly linked to dementia risk. However, higher cumulative use (above 90 TSDs) was associated with increased risk, with incidence rate ratios (IRRs) ranging from 1.16 to 1.59 depending on age and dose levels. The association remained consistent in individuals with chronic pain and those using only weak opioids, underscoring a potential dose-dependent relationship.
These findings carry important implications for clinical practice. While opioids are essential for managing certain types of pain, healthcare providers should carefully weigh the risks and benefits, particularly for chronic noncancer pain patients requiring higher cumulative doses. Early intervention strategies, alternative pain management options, and further research are critical to understanding whether this association indicates causality or reflects other underlying factors. Monitoring opioid use in populations at risk could help mitigate potential long-term consequences.
Reference
Pourhadi N et al. Opioids and dementia in the Danish population. JAMA Netw Open. 2024;7(11):e2445904.
