Over the past decade, physicians, patients and policy makers have expressed increasing concern about the high frequency of opioids being prescribed and the association between opioid use and poor outcomes. Rates of opioid prescriptions in the general population rose considerably from the 1990s through 2010, with a plateau in the early 2010s. In 2015, 38% of U.S. adults reported using opioids, and, of these individuals, 17% had an opioid use disorder. Compared with other medications for chronic pain (e.g., anticonvulsants, tricyclic antidepressants), opioids are associated with significantly increased risk of overdose-related mortality, as well as non-overdose deaths, particularly cardiovascular deaths.
The opioid epidemic is a major public health concern. However, little is known about opioid use among rheumatoid arthritis (RA) patients. The authors of this study set out to examine trends in chronic opioid use in RA patients in 2002–2015 and to identify clinical predictors.
Methods: RA patients were identified from the Corrona registry, which is supported by AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Crescendo, Eli Lilly, Genentech, GlaxoSmithKline, Horizon Pharma, Janssen, Momenta Pharmaceuticals, Novartis, Pfizer, Roche and UCB. Opioid use was ascertained from surveys obtained at clinical visits as often as every three months. Chronic opioid use was defined as any opioid use reported during two or more consecutive study visits. Annual prevalence of chronic opioid use was calculated using data from 33,739 RA patients with information on opioid use from two or more visits. Among the 26,288 individuals who were not taking opioids at baseline, Cox proportional hazards models identified associations between patient characteristics and incident chronic opioid use.
Results: Chronic opioid use increased from 7.4% in 2002 to 16.9% in 2015. Severe pain (HR 2.53 [95% CI 2.19–2.92]) and antidepressant use (HR 1.79 [95% CI 1.64–1.92]) were associated with an increased risk of chronic opioid use. High disease activity (HR 1.55 [95% CI 1.30–1.84]) and a high level of disability (HR 1.45 [95% CI 1.27–1.65]) were also associated with chronic opioid use. Medicaid insurance (HR 1.30 [95% CI 1.09–1.55]), and Medicare insurance (HR 1.27 [95% CI 1.12–1.44]) were also significantly associated with incident chronic opioid use. In addition, medications for RA, specifically glucocorticoids (HR 1.14 [95% CI 1.04–1.25]) and a number of previous DMARDs (HR 1.08 [95% CI 1.04–1.11]), were associated with a risk of incident chronic opioid use. Conversely, Asian ethnicity (HR 0.49 [95% CI 0.36–0.68]) was associated with a decreased risk of chronic opioid use.
Conclusion: Among RA patients, chronic opioid use doubled from 2002 to 2015. Pain and antidepressant use were the strongest predictors of chronic opioid use. 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.
Excerpted and adapted from:
Lee YC, Kremer J, Guan H, et al. Chronic opioid use in rheumatoid arthritis: Prevalence and predictors. Arthritis Rheumatol. 2019 May;71(5):670–677.