Incident opioid use is associated with risk of respiratory harm in non-palliative COPD
Bibliographic record
Abstract
We thank M. Ekström and co-workers for their interest in our manuscript [1] and for their contributions to the important topic of opioid drug use in chronic obstructive pulmonary disease (COPD). M. Ekström and co-workers stress the efficacy of selective use of opioids for refractory breathlessness in COPD. We acknowledged in our manuscript [1] that several clinical studies demonstrate that opioids are efficacious in selected COPD patients for relieving refractory breathlessness. However, we have previously outlined reasons why such trials of drug efficacy have limited ability to comprehensively evaluate for possible drug harms [1–3]. Furthermore, chronic musculoskeletal pain, and not respiratory symptoms, is likely the more common reason why individuals with COPD use opioid drugs [3, 4]. Indeed, M. Ekström and co-workers recently published data showing that 97% of opioid prescriptions among Swedes with advanced COPD were for pain [5]. Several Cochrane reviews have suggested there is insufficient evidence to support the use of opioids for chronic musculoskeletal pain [6–8]. The potential for respiratory-related harm needs to be considered when using opioid drugs in non-palliative COPD
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.019 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".