Long-Term Opioid Use Observed for 1 in 5 with Rheumatic or Musculoskeletal Disorders

Meghna Jani, MRCP, PhD
Credit: ResearchGate

New data from an analysis of more than 800,000 people with rheumatic and musculoskeletal disorders details the prevalence and trends in long-term opioid use among these patient populations.

Results of the study suggest up to 1 in 5 patients with a rheumatic or musculoskeletal disorder met the criteria for long-term opioid use, with this prevalence increasing to 1 in 3 for people with fibromyalgia or rheumatoid arthritis.

“Health professionals should be aware of the high proportion of long-term opioid use in patients with RMDs. Introduction of prompt interventions, such as medication reviews or de-prescribing, to ensure the appropriateness of long-term opioid therapy, and proactive consideration of non-pharmacological treatments for pain relief would also be of benefit to reduce avoidable harms in this patient population.”

The opioid epidemic was, and remains, one of the greatest public health crises in US history. With drug overdose deaths quintupling from 1999 to 2020, the US witnessed more than 560,000 deaths from overdose involving any opioid during the same period.²

Led by Meghna Jani, MRCP, PhD, a National Institute for Health and Care Research fellow and clinical senior lecturer at the Centre for Epidemiology Versus Arthritis at the University of Manchester, the current study was launched with the intent of exploring the frequency of long-term opioid use among patients with rheumatic and musculoskeletal disorders initiation opioids for the first time using contemporary data. To do so, Jani and a team of investigators from Manchester, England designed their study as an analysis of data obtained from the Clinical Practice Research Datalink.¹

Using the database, investigators performed a search for adult patients with a diagnosis of rheumatoid arthritis, psoriatic arthritis (PsA), axial spondyloarthritis (AxSpA), systemic lupus erythematosus (SLE), osteoarthritis, and fibromyalgia and without prior cancer. For the purpose of analysis, new opioid use was described as having no opioid prescriptions in the prior 2 years and being prescribed up to 6 months before or any time after a diagnosis of interest from Jaunty 1, 2006-October 31,2021. Investigators noted patients were required to have at least 1 full year of follow-up data.¹

Overall, 841,047 patients were identified for inclusion in the current study. The majority of this cohort was patients with osteoarthritis, representing 796,276 of the 841,047 patients. The rest of the group was comprised of 12,260 with rheumatoid arthritis, 5195 with PsA, 3046 with AxSpa, 3081 with SLE, and 21,189 with fibromyalgia. Upon analysis, results indicated there were 1,081,216 new episodes of opioid use. Of these, 16.8% transitioned to long-term use using the standard definition, 11.1% using the stringent definition, and 21.9% using the broad definition.¹

The primary outcomes of interest for each cohort were the proportions and trends over time of long-term opioid use. For the purpose of analysis, trends in the proportions of use over time for each disorder were assessed using negative binomial regression models, with year used as a continuous variable.¹

Analysis of trends and proportion of use revealed the highest proportion of long-term opioid users among the 6 disorders of interest were patients with fibromyalgia (27.4% for Standard, 20.9% for Stringent and 33.7% for Broad), followed by rheumatoid arthritis (25.7%, 18.5% and 32.3%, respectively) and AxSpA (23.8%, 17.3% and 29.6%, respectively). In contrast, the lowest rate of long-term opioid use was observed among the cohort of patients with osteoarthritis, with rates of 16.4%, 10.7% and 21.4% using the standard, stringent, and broad definitions, respectively.¹

Investigators pointed out analyses of trends over time indicated both SLE and fibromyalgia had statistically significant increasing trends, with a notable increase from 21.7% to 33.0% between 2006-2019 and 28.9% in 2020 among people with fibromyalgia. Investigators also pointed out a significant decreasing trend among those with rheumatoid arthritis, but the overall proportion in 2020 remained high at 24.4%.¹

“The findings warrant vigilance in practice of opioid prescribing for [rheumatoid and musculoskeletal conditions] since long term opioid therapy is associated with poor outcomes (eg, opioid dependence and opioid-related adverse events),” wrote investigators.³

References:

1. Huang YT, Jenkins DA, Peek N, Dixon WG, Jani M. High frequency of long-term opioid use among patients with rheumatic and musculoskeletal diseases initiating opioids for the first time [published online ahead of print, 2023 May 16]. Ann Rheum Dis. 2023;ard-2023-224118. doi:10.1136/ard-2023-224118
2. Understanding the opioid overdose epidemic. Centers for Disease Control and Prevention. June 1, 2022. Accessed May 17, 2023. https://www.cdc.gov/opioids/basics/epidemic.html.
3. The BMJ. Patients with rheumatic and musculoskeletal conditions vulnerable to long term opioid use. EurekAlert! May 16, 2023. Accessed May 17, 2023. https://www.eurekalert.org/news-releases/989179.