Long-term prescription opioids linked to increased risk of esophageal dysfunction

A Health Canada safety review has discovered a possible link between the long-term use of prescription opioids and the risk of impaired esophageal function. The safety review was spurred by Health Canada’s identification of several scientific studies reporting a possible association between the long-term use of opioids and esophageal dysfunction, with the dysfunction confirmed by esophageal pressure tests that measure how well the esophagus is working.1The following prescription opioids were included in the safety review: buprenorphine, butorphanol, codeine, diamorphine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, nalbuphine, normethadone, oxycodone, tapentadol and tramadol.1 The safety review included information from searches of the scientific literature and the Canada Vigilance database. At the time of the review, Health Canada had received 28 Canadian reports of esophageal dysfunction in patients taking prescription opioids. However, none of these cases met the criteria for further assessment because of incomplete information in the reports, lack of information about when or how long the opioid was taken relative to the esophageal dysfunction, or the reported diagnosis was not confirmed by esophageal pressure testing.1Health Canada reviewed 14 international cases of esophageal dysfunction in patients taking prescription opioids. Of these 14 cases, three were found to be probably linked to the use of prescription opioids and 11 were found to be possibly linked.1 The patients in the 14 cases were taking opioid doses equivalent to morphine 30–300 mg/day, with a midrange daily dose of 67.5 mg/day. Esophageal dysfunction was more likely to occur in patients taking higher daily opioid doses. The most common symptoms of esophageal dysfunction were difficulty swallowing, gastroesophageal reflux and chest pain. The time to onset of symptoms ranged from several weeks to months after starting opioids.1 In a recent study, esophageal motility disorders resolved in 10 of 19 patients with suspected opioid-induced esophageal dysfunction when opioids were discontinued for at least seven days.2 Health Canada’s review of articles published in the scientific literature identified potential biological mechanisms that may explain how the long-term use of prescription opioids could lead to esophageal dysfunction.1 For example, chronic opioid use may interfere with inhibitory signals involved in control of esophageal motility, allowing for unchecked excitatory stimuli, leading to spastic contractility and impaired esophagogastric junction relaxation.3Health Canada is working with pharmaceutical manufacturers to update the Canadian product monographs for prescription opioids to include the risk of esophageal dysfunction with long-term use.1References:Government of Canada. Summary safety review - prescription opioids (buprenorphine, butorphanol, codeine, diamorphine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, nalbuphine, normethadone, oxycodone, tapentadol and tramadol) - assessing the potential risk of esophageal dysfunction with long-term use. August 8, 2025. (accessed August 12, 2025).Ezquerra-Durán A, Alcalá-González L, Araujo IK, et al. Prospective evaluation of opioid cessation in patients with suspected opioid-induced esophageal dysfunction. Am J Gastroenterol 2025;120(6):1400-4. DOI: 10.14309/ajg.0000000000003297.Snyder DL, Vela MF. Opioid-induced esophageal dysfunction. Curr Opin Gastroenterol 2020;36(4):344-50. doi: 10.1097/MOG.0000000000000648.

Long-term prescription opioids linked to increased risk of esophageal dysfunction

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