Regular use of opioids and dementia, cognitive measures, and neuroimaging outcomes among UK Biobank participants with chronic non‐cancer pain

Abstract INTRODUCTION We investigated the association between regular opioid use and incident dementia, neuroimaging outcomes, and cognitive measures. METHODS Cox regression was used to assess the association between opioid use and incident dementia among197,673 UK Biobank participants with chronic non‐cancer pain. Linear and logistic regression were applied to explore the associations between opioid use and dementia‐related neuroimaging and cognitive function outcomes. RESULTS Regular opioid use was associated with a 20% higher risk of all‐cause dementia and a 49% higher risk of vascular dementia (VD) compared with those not using analgesics. Moreover, those using strong opioids had a 72% higher risk of all‐cause dementia and a 155% higher risk of VD. Strong opioid use was also linked to reductions in hippocampal, white matter, and total brain volumes. Lastly, regular opioid use was associated with lower fluid intelligence. DISCUSSION A higher risk of dementia was observed among participants regularly using opioids, escalating with opioid strength. Highlights Regular opioid use was associated with an increased risk of all‐cause dementia and VD. Those using strong opioids had a much higher risk of all‐cause dementia and VD. Strong opioid use was also associated with worse neuroimaging outcomes. Regular opioid use was also associated with lower fluid intelligence.