Adrenal function in long-term opioid use
Research type
Research Study
Full title
Adrenal function in long-term therapeutic opioid use in adults
IRAS ID
241332
Contact name
Jeanette Wells
Contact email
Clinicaltrials.gov Identifier
n/a, n/a
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Opioid medications are increasingly used of for pain relief. In England, opioid use rose 10% from 2003 to 2013 and approximately 6.4 million prescriptions were issued for morphine sulphate, buprenorphine and oxycodone every year. Opioids increase mortality in elderly subjects and is known to cause low testosterone in about 75% males and low oestrogen in 21% females treated for pain. This affects quality of life, and domestic and social harmony in those affected. Evidence is increasing that opioids similarly affect the adrenal glands which produce the life sustaining hormone, cortisol. In chronic opioid injections to the spine, the adrenal glands are inhibited in 15%. This occurs with oral and transdermal opioid use as well. How common this type of adrenal gland suppression is not known currently because of a lack of studies examining this issue. A recent small study found low 9 am cortisol levels (an index of adrenal function) in 4 out of 48 chronic opioid users (8.3%) - 3 of them failed a short Synacthen test (SST) which is the gold standard for measuring adrenal function, indicating that the opioids have caused suppression of the adrenal glands in them. This is also likely to be due inhibition of a regulatory hormone from the hypothalamus that promotes adrenal hormone secretion through intermediate mechanisms. This aspect of chronic opioid therapy has not been studied in large numbers of subjects. Therefore, effects on morbidity and mortality (particularly at times of “stress’), and quality of life measures, have not been assessed formally in these subjects. We feel this is important to investigate because low adrenal hormone levels particularly during stress, may cause major morbidity and even death.
We aim to recruit between 200-300 subjects on chronic opioid therapy to check their 9 am salivary cortisol levels and perform a SST.REC name
London - Riverside Research Ethics Committee
REC reference
18/LO/1961
Date of REC Opinion
6 Dec 2018
REC opinion
Further Information Favourable Opinion