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Cover of Drug Class Review: Long-Acting Opioid Analgesics

Drug Class Review: Long-Acting Opioid Analgesics

Final Update 6 Report

Drug Class Reviews

, MPH, , MPA: HA, , BA, , DO, and , MD.

Portland (OR): Oregon Health & Science University; .

Structured Abstract


We compared the effectiveness and harms of long-acting opioids and of long-acting opioids compared with short-acting opioids in adults with chronic noncancer pain.

Data Sources:

To identify published studies, we searched MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and reference lists of included studies. We also searched the US Food and Drug Administration Center for Drug Evaluation and Research website for additional unpublished data and solicited dossiers of information from pharmaceutical manufacturers.

Review Methods:

Study selection, data abstraction, validity assessment, grading the strength of the evidence, and data synthesis were all carried out according to standard Drug Effectiveness Review Project review methods.

Results and Conclusions:

Although we identified 10 head-to-head trials comparing 2 or more long-acting opioids, the evidence was insufficient to determine if there are differences among long-acting opioids in effectiveness or harms. Eight trials found no statistical difference in pain relief or function between long-acting opioids. The 2 trials which found a significant difference were both open-label, rated poor quality, and were inconsistent with higher-quality trials evaluating the same comparison that found no significant differences. A shortcoming of the currently available evidence is that comparisons between specific long-acting opioids have been evaluated in only 1 to 3 trials each (most with small sample sizes), which may limit statistical power for detecting true differences. Studies that provided indirect data were too heterogeneous in terms of study design, patient populations, interventions, assessed outcomes, and results to make accurate judgments regarding comparative efficacy or adverse event rates. Evidence was insufficient to determine if long-acting opioids as a class are more effective or associated with fewer harms than short-acting opioids. There was also insufficient evidence to draw conclusions about comparative effectiveness or safety in subgroups.


Update 5: April 2008; Update 4: April 2006; Update 3: April 2005; Update 2: April 2004; Update 1: September 2003; Original Report: November 2002

The medical literature relating to this topic is scanned periodically. (See for description of scanning process). Prior versions of this report can be accessed at the DERP website.

Drug Effectiveness Review Project, Marian McDonagh, PharmD, Principal Investigator.
Oregon Evidence-based Practice Center, Mark Helfand, MD, MPH, Director, Oregon Health & Science University

Acknowledgments: We thank Leah Williams, our publications editor, for putting this report into its present form for you to read.

Authors of previous updates: Update 5 authors: Roger Chou, MD and Susan Carson, MPH. Update 2, 3, and 4 authors: Roger Chou, MD. Original Report and Update 1 authors: Roger Chou, MD and Elizabeth Clark, MD, MPH

Funding: The Drug Effectiveness Review Project, composed of 12 organizations including 11 state Medicaid agencies, and the Canadian Agency for Drugs and Technology in Health commissioned and funded for this report. These organizations selected the topic of the report and had input into its Key Questions. The content and conclusions of the report were entirely determined by the Evidence-based Practice Center researchers. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in this report.

Suggested citation:

Carson S, Thakurta S, Low A, Smith B, Chou R. Drug class review: Long-acting opioid analgesics. Update 6 final report. Prepared by the Oregon Evidence-based Practice Center for the Drug Effectiveness Review Project. Oregon Health & Science University. Portland, OR. 2010. Available at:

The purpose of Drug Effectiveness Review Project reports is to make available information regarding the comparative clinical effectiveness and harms of different drugs. Reports are not usage guidelines, nor should they be read as an endorsement of or recommendation for any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.

Copyright © 2011 by Oregon Health & Science University.
Bookshelf ID: NBK62335PMID: 21977550


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