Opioids and Infections in the Intensive Care Unit Should Clinicians and Patients be Concerned?

There is a large body of experimental evidence in research animals and in vitro models that opioids suppress the immune system. If this effect occurs in acute human disease, then patients cared for in Intensive Care Units (ICUs) would be a particularly vulnerable population. ICU patients have the most severe forms of acute infection, have the greatest risk of acquiring new infections in the hospital, and are exposed to high doses of opioids for long periods of time. We review the epidemiology of ICU infections and the pharmacoepidemiology of opioid use in critically ill patients. We critique the limited human research examining the relationship between opioids and infection and make recommendations on designing future clinical studies that could close the knowledge gap about the true hazards of opioid use in hospitalized patients. Grant support for S Roy: NIH RO1 DA12104, RO1 DA022935, KO2 DA015349, P50 DA11806, and T32 DA0709 (codirector). Presented in a shortened version as an oral presentation at the Society for Neuroimmune Pharmacology meeting in Charleston, SC, USA in March 2008.