Rheumatic diseases: high rates of long-term prescription opioid use

  • Chen SK & al.
  • BMJ Open
  • 19/06/2019

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Rheumatic diseases have high rates of long-term (≥90 days) prescription opioid use, with ankylosing spondylitis (AS) leading the way and systemic lupus erythematosus (SLE) having the lowest likelihood compared with hypertension, the nonpainful control condition.

Why this matters

  • This is the first large study of long-term opioid use in rheumatic diseases.
  • Findings will help target strategies to reduce opioid use.

Study design

  • Analysis of prescription claims from the Truven MarketScan, a US commercial claims database, 2003-2014, for long-term opioid use (during 1-year of follow-up) in rheumatoid arthritis (RA; n=181,710), AS (n=7686), SLE (n=45,834), and psoriatic arthritis (PsA; n=30,307).
  • Relative risks (RRs) of long-term opioid use were calculated vs hypertension (n=265,537; matched by age and sex).
  • Funding: Brigham and Women's Hospital; Harvard Medical School.

Key results

  • Rates of long-term prescription opioid use:
    • AS, 25%.
    • RA, 19%.
    • SLE, 16%.
    • PsA, 15%.
    • Hypertension, 5%-6%.
  • The RR (highest to lowest) of receiving long-term opioid prescriptions in each rheumatic disease vs hypertension in multivariate analysis:
    • AS (RR, 2.73; 95% CI, 2.60-2.87).
    • RA (RR, 2.21; 95% CI, 2.16-2.25).
    • PsA (RR, 1.94; 95% CI, 1.87-2.00). 
    • SLE (RR, 1.82; 95% CI, 1.77-1.88).

Limitations

  • Lack of information about disease severity, pain, and other patient characteristics.
  • Analysis ended in 2014, which may not be generalizable to 2019.