Development of a Screening Tool for Opioid-Induced Endocrinopathy in Adult Patients

Emma Murter; Benjamin Miskle; Lorin Fisher; Michelle Schmidt; James Ray

doi:10.1080/15360288.2023.2234264

Background: In 2020, over 142 million prescriptions were written for opioids in the United States, and over 9.5 million people used non-prescribed opioids. More commonly known adverse effects associated with the use of opioids include constipation, nausea, immunosuppression, and respiratory depression. A lesser-known adverse effect is opioid-induced endocrinopathy. Most opioids are mu-, kappa-, and delta-receptor agonists or demonstrate mixed activity (i.e., buprenorphine). Opioids can also bind epsilon-opioid receptors densely located within the hypothalamus. It is theorized that opioid-induced endocrinopathy is a dysfunction along the hypothalamus-pituitary-gonadal and adrenal axes secondary to mu- and epsilon-opioid receptor activity. It is suspected that 21-86% of patients taking chronic opioids experience some form of endocrinopathy. More evidence is needed to proactively identify and treat patients with opioid-induced endocrinopathy. Methods: The primary objective of this study was to develop a screening tool for specific opioid-induced endocrinopathies including thyroid dysfunction, androgen deficiency, adrenal insufficiency, and osteoporosis or osteopenia. A systematic literature review was completed to find supporting evidence to create the clinical screening tool. Literature was analyzed for study design, key findings, and methodology. Literature was evaluated by themes for clinical, laboratory, and invasive screening. Results: Findings from the systematic literature review supported objective data for thyroid dysfunction, androgen deficiency, adrenal insufficiency, and osteoporosis or osteopenia to be integrated into an opioid-induced endocrinopathy clinical screening tool. Patients more likely to experience opioid-induced endocrinopathy include patients with exposure to long-acting versus short-acting opioids, higher doses of opioids, and longer durations of opioid use. Data supports that buprenorphine causes less profound endocrinopathy compared to full mu-opioid receptor agonists. Additionally, persons assigned female at birth appear to be protected from bone mineral density loss related to opioid-induced endocrinopathy. Conclusion/Impact: In conclusion, the developed screening tool for opioid-induced endocrinopathy utilizes laboratory and clinical information that is evidence-based. This tool is not intended to justify an opioid rotation, de-escalation in opioid therapy, or discontinuation of opioid therapy; rather, this tool may facilitate the conversation of potential risks and benefits of opioid therapy for persons with malignant pain or an opioid use disorder.

Development of a Screening Tool for Opioid-Induced Endocrinopathy in Adult Patients

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