People who use drugs often experience a constellation of physical, mental health, and psychiatric comorbidities, creating a syndemic of overlapping conditions that exacerbate vulnerability to poor health outcomes. Chronic opioid exposure (COE) is increasingly recognized as a risk factor for adverse cardiovascular events, particularly among individuals who inject drugs. Previous work has generally focussed on cardiovascular infections and arrhythmias. Research on the relationship between chronic opioid use and atherosclerotic cardiovascular disease (CVD) remains limited, leaving critical gaps in understanding the pathophysiological and epidemiological links.
Joe Schofield, DigitAS Senior Research Fellow, is researching the association between chronic opioid exposure and atherosclerotic cardiovascular disease. Through the CO-CARDIO project he aims to:
- Detect and characterise any association between COE and CVD
Explore the nature and magnitude of any association between COE and CVD, including potential dose-response relationships and the role of opioid type (street drugs, treatment for opioid use disorder, and prescription analgesics). - Understand multimorbidity
Examine how CVD clusters with other physical and mental health conditions, including the role of polysubstance use and polypharmacy, in people who use opioids. - Identify modifiable risk factors
Identify demographic, behavioural, clinical, and pharmacological factors that can plausibly mediate or modify the relationship between opioid use and harmful health outcomes, particularly CVD.
Joe has chaired and presented symposia on CVD among people with opioid use disorder at two meetings of the International Society of Addiction Medicine, sharing emerging results from this DigitAS workstream with global addiction policy makers and practitioners.
Outputs
Schofield, J., Conti, A., Khan F., Baldacchino, A. (submitted) Association between chronic opioid exposure and cardiovascular disease: a systematic review and meta-analysis
Schofield, J., Arab, A., Abubaker, H.A., Khan, F., Baldacchino A. (submitted) Chronic opioid prescribing and hospital admissions for cardiovascular disease: A retrospective cohort study utilising a linked dataset analytic approach
Schofield, J., Papathomas, M., Macnamara, C., McCann, M., Ardestani, B., Letina, S., Skivington, K., Khan, F., Baldacchino A. (in press) Contextualising multimorbidity in people who use drugs: analysis of drug-death decedents in Scotland Irish J. of Psychological Medicine
Schofield, J., Arab, A., Forget, P. (Sep 2024) The cardiovascular effects of chronic opioid use: considerations for the prevention of drug-related deaths and premature mortality, and the treatment of opioid use disorder International Society of Addiction Medicine, Istanbul
Schofield, J., Khan, F., Galea-Singer, S. (May 2025) Cardiovascular disease among people with opioid use disorder in the context of multiple morbidity: mechanisms, needs, and responses International Society of Addiction Medicine, Hamburg
