What are the characteristics of vitamin D metabolism in opioid dependence? An exploratory longitudinal study in Australian primary care.
BMJ Open. 2018 Jan 13;8(1):e016806. doi: 10.1136/bmjopen-2017-016806.
Reece AS1, Hulse GK2,3.
- 1 Department of Psychiatry and Clinical Neurosciences, University of Western Australia, Brisbane, Queensland, Australia.
- 2 Department of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Queensland, Australia.
- 3 Psychiatry, Edith Cowan University at Joondalup, Western Australia, Australia.
- Overview Pain and Vitamin D
- Chronic Pain reported 38 percent less often if supplemented with Vitamin D – meta-analysis Sept 2016
- Palliative cancer benefit of 4,000 IU of Vitamin D – less opioids, infection, and CRP – Aug 2017
Chart showing decreased use of Opiates among Cancer patients taking vitamin D
Vitamin D titles containing: Opioid OR Opiate OR Morphine
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Increased age, decreased association
Stronger association for men
Opioid depedents have LOWER vitamin D levels than controls after 4 years
Compare vitamin D levels in opioid dependence and control population and adjust for relevant confounding effects. Nuclear hormone receptors (including the vitamin D receptor) have been shown to be key transducers and regulators of intracellular metabolism and comprise an important site of pathophysiological immune and metabolic dysregulation potentially contributing towards pro-ageing changes observed in opioid-dependent patients (ODPs).
DESIGN: Longitudinal prospective comparing ODPs with general medical controls (GMCs).
SETTING: Primary care.
PARTICIPANTS: Prospective review comparing 1168 ODP (72.5% men) and 415 GMC (51.6% men, p<0.0001). Mean ages were 33.92±0.31 (mean±SEM) and 41.22±1.32 years, respectively (p<0.0001). Opioid use in the ODP has been previously reported and shown to be typical.
INTERVENTIONS: Nil. Observational study only.
PRIMARY AND SECONDARY OUTCOMES: Serum vitamin D levels and relevant biochemical parameters.
RESULTS: Vitamin D levels were higher in the ODP (70.35±1.16 and 57.06±1.81 nmol/L, p<0.0001). The difference in ages between the two groups was handled in an age-matched case-control subanalysis and also by multiple regression. Sexes were analysed separately. The age:status (or age:time:status) was significant in case-control, cross-sectional and longitudinal analyses in both sexes (p<0.05).
Modelled vitamin D was 62.71 vs 57.81 nmol/L in the two groups (8.47% higher) . Time-dependent mixed-effects models quadratic in age outperformed linear-only models (p=0.0377). ODP vitamin D was shown to vary with age and to correlate with alanine aminotransferase establishing it as a biomarker of age in this group. Hepatitis C seronegativity was significant in regression models (from p=0.0015).
CONCLUSION:
Vitamin D was higher in ODP in both sexes in bivariate, cross-sectional, case-control and longitudinal analyses and was robust to the inclusion of metabolic and immune biomarkers. That Hepatitis C seronegativity was significant suggests opioid dependence has an effect beyond simply that of its associated hepatitides. This finding may relate to the accelerated ageing process previously described in opioid dependence.
PMID: 29331964 DOI: 10.1136/bmjopen-2017-016806