Caution, more education needed on opioid use in people with heart disease, stroke

By American Heart Association News

ah_designs/iStock, Getty Images
(ah_designs/iStock, Getty Images)

The continued rise in opioid overdose deaths has health experts concerned about the drugs' impact on heart and brain health, and a new report suggests strategies to help curb deaths and better manage pain in people with heart disease and stroke.

The presidential advisory from the American Heart Association, published Thursday in its journal Circulation, cites Centers for Disease Control and Prevention statistics showing 2 in 3 overdose deaths involved opioids. Opioid overdose resulted in 49,860 deaths in 2019, according to CDC data.

"Opioid abuse accelerated during the COVID-19 pandemic due to disruption of the illicit drug supply environment, more limited access to medications, and social isolation and depression related to pandemic safety measures," writing group chair Sheryl Chow said in a news release. Chow is an associate professor of pharmacy practice at Western University of Health Sciences in Pomona, California, and associate clinical professor of medicine at the University of California, Irvine.

Based on data culled from more than 90 evidence-based studies and other scientific papers, the advisory includes recommendations, algorithms and guidance for health care professionals and researchers who specialize in heart and brain health. The report was developed through a collaboration between the AHA and leading health experts, including doctors, scientists and a pharmacist.

Opioids commonly used for pain management may interfere with medications used to manage and treat cardiovascular disease and may therefore need to be adjusted, the committee said. For example, morphine, used to manage pain in some heart patients, may reduce the effectiveness of drugs to prevent blood clots. The committee also called for research to focus on identifying opioid misuse in people with heart disease.

"Health care professionals who manage pain in the setting of cardiovascular disease and stroke should be encouraged to receive training in management of pain using non-opioid strategies and on screening for opioid use disorder," Chow said.

In cases of cardiac arrest, the advisory recommends the public first call 911 and start CPR before administering naloxone, an emergency drug used in an overdose. Naloxone only is effective if opioid overdose is the cause of the cardiac arrest, the committee said, and lay people may not be able to identify if an overdose has occurred.

"Lay responders should also be encouraged to receive formal CPR training with specific instructions on naloxone administration because opioid overdose often occurs in public, and CPR is more likely to be given by bystanders," Chow said.

Federal, state and local health and law enforcement agencies should take a coordinated approach to opioid management, the committee advised. It also called for employer-based programs to support treatment for addiction and the expansion of free syringe exchange programs to reduce needle sharing for intravenous drug use, which can cause a serious infection of the heart lining.

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