LOWELL, MA — Opioid-related harm might be signaled early on by neurocognitive symptoms (NCS).
A new study sought to evaluate the incidence and potential attribution of opioid-related NCS among patients on long-term opioid therapy (LOT). To do so, the University of Massachusetts-led researchers used natural language processing to extract data from the electronic health records within the VHA. The VA Connecticut Healthcare System in West Haven and the VA Bedford, MA, Healthcare System participated in the research.
In the study published in The Clinical Journal of Pain, the investigators conducted a retrospective cohort study of patients prescribed LOT in 2018. NCS were identified from clinical notes across three periods: 6 months before LOT initiation, during LOT, and 1-year post-LOT discontinuation. The researchers defined opioid-related NCS as cognitive impairment, sedation, light-headedness, altered mental status and intoxication, calculating incidence rates, incidence rate ratios and hazard ratios to evaluate the occurrence and potential opioid attribution of NCS across these periods.1
Results indicate that 3.1% of the 55,652 patients experienced opioid-related NCS, with the highest incidence observed during LOT. “Prevalence of NCS was greater in patients who were: between 55 and 64 (3.6%) or 65 and 74 years old (3.2%), Asian (4.8%, P = 0.02), and had received treatment for substance use disorders (7.1%, P = 0.01),” the researchers wrote, adding, “In adjusted proportional hazards models, identified Asian race (hazard ratio: 2.20 [95% CI: 1.09-4.44], P = 0.03), and co-occurring conditions dementia (1.50 [1.12-2.00], 0.01), depression (1.31 [1.14-1.49], <0.01), posttraumatic stress disorder (1.18 [1.02-1.37], 0.02), substance-use disorder (1.62 [1.36-1.92], 0.01), cardiovascular disease (1.18 [1.01-1.37], 0.04), chronic obstructive pulmonary disease (1.16 [1.01-1.33], 0.03), cirrhosis (1.73 [1.34-2.24], 0.01), chronic kidney disease (1.41 [1.19, 1.66]; 0.01) and traumatic brain injury (1.42 [1.06-1.91], 0.02) were associated with increased likelihood of NCS. Likelihood of NCS increased with LOT dose and decreased with LOT duration.”
The study suggested that opioid-related NCS are most likely to occur during long term use. “These findings highlight the importance of monitoring NCS in patients on LOT as part of a broader strategy to mitigate opioid-related harms,” the authors wrote.
- León C, Sung ML, Reisman JI, Liu W, Kerns RD, Gordon KS, Mitra A, Kwon S, Yu H, Becker WC, Li W. Occurrence of Opioid-Related Neurocognitive Symptoms Associated With Long-term Opioid Therapy. Clin J Pain. 2025 Feb 1;41(2):e1266. doi: 10.1097/AJP.0000000000001266. PMID: 39682036.
