Chronic opioid use continues to increase in people with RA
medwireNews: The annual prevalence of chronic opioid use among people with rheumatoid arthritis (RA) more than doubled between 2002 and 2015, with severe pain and antidepressant use the strongest predictors for initiating opioids, US researchers report.
Yvonne Lee (Brigham and Women’s Hospital, Boston, Massachusetts) and colleagues say that it is important to consider their findings “within the context of the opioid epidemic”.
They note that although studies have shown that opioid prescription rates reached a plateau after 2010, these “included data from the general population, rather than a specific chronic disease population, indicating that factors influencing the decrease in opioid prescriptions in the general population (e.g., withdrawal of propoxyphene from the market, increased physician and patient education on the risks of opioid use) may be less influential when considering opioid prescriptions for specific chronic pain populations, such as RA.”
Lee and team found that chronic opioid use, defined as any opioid use reported by the patient during at least two consecutive study visits, increased from 7.4% in 2002 to 16.9% in 2015 among the 33,739 participants with RA identified from the Consortium of Rheumatology Researchers of North America (Corrona) registry.
In an analysis of 26,288 individuals who were not taking opioids at baseline, severe pain and antidepressant use were the strongest independent predictors of chronic opioid use, with adjusted hazard ratios (HRs) of 2.53 and 1.79, respectively.
The risk of opioid use increased with increasing disease activity, from a HR of 1.31 among patients with a low Clinical Disease Activity Index (CDAI) score (>2.8–10) to a HR of 1.55 among those with high disease activity (CDAI >22) when compared with those in remission.
There was also an increased risk with increasing Health Assessment Questionnaire Disability Index scores, from a HR of 1.36 among those with a score of >0.5–1.0 to a HR of 1.45 among those with a score above 1.0,relative to a score of 0.5 or lower.
Other independent predictors of incident opioid use included Medicaid insurance (HR=1.30), Medicare insurance (HR=1.27), corticosteroid use (HR=1.14) and number of previous DMARDs (HR=1.08), whereas Asian race was associated with a decreased risk of chronic opioid use (HR=0.49).
Writing in Arthritis & Rheumatology, Lee et al conclude that their findings “highlight the importance of: a) treating inflammatory disease activity aggressively with a treat-to-target strategy, and b) evaluating and treating pain and mental health problems, before prescribing opioid medications and in addition to treating with DMARDs.”
They conclude: “To curb the rise in chronic opioid use, strategies for stringent control of RA disease activity and management of pain and depression should be research priorities.”
By Laura Cowen
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