medwireNews: Over a 1-year period, around one in four individuals with hip and/or knee osteoarthritis (OA) received opioids for pain management, compared with approximately one in 10 people without such a diagnosis, finds a Swedish population-based study.
“These results highlight that patients with knee and hip OA constitute a group of patients with an alarmingly high use of opioids,” remark the researchers.
And they note that “[t]he high rates of opioid dispensing for patients with knee and/or hip OA is controversial given the reluctance of clinical guidelines for recommending opioids for OA patients due to risk of adverse events and addiction.”
Using data from a registry including 751,579 residents of a southern Swedish county who were aged at least 35 years, the team found that the 12-month prevalence of any dispensed opioids was 23.6% among individuals diagnosed with knee and/or hip OA and 9.6% for those without OA. This gave a prevalence ratio of 2.1 after adjusting for factors such as age, sex, civil status, and income.
The incidence of dispensed opioids – which indicated new use of the drugs – was similarly higher among people with versus without OA, at an incidence rate of 137 and 54 per 1000 person–years, respectively, equating to an adjusted incidence rate ratio of 2.3.
And 11.8% of any incident opioid prescriptions could be attributed to patients with knee and/or hip OA, report Jonas Thorlund, from the University of Southern Denmark in Odense, and colleagues. The population attributable fraction of knee and/or hip OA for incident use of weak opioids (eg, codeine) was 9.0%, while it was 16.7% for strong opioids (eg, morphine).
As “time-limited postoperative use of opioids is often standard” after joint replacement, the investigators excluded opioid use within 30 days of being discharged after surgery in a sensitivity analysis, and unsurprisingly found a decrease in the incidence rate of strong opioids dispensed.
They point out, however, that “incidence rate ratios between individuals with knee and/or hip OA and the population without OA were only marginally attenuated, suggesting that opioid use is elevated in persons with OA not undergoing surgery or can persist long after surgical intervention.”
Thorlund et al therefore conclude in Osteoarthritis and Cartilage that these “[f]indings call for increased awareness and better utilization of other core OA treatments, as well as point to a general need for better management of OA as a growing public health concern.”
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