Opioid Use Disorder Hospitalizations Increasing Among Rheumatic Disorders

Jasvinder Singh, MD

New research from the University of Alabama at Birmingham has uncovered a startling new trend among patients with rheumatic diseases.

Results of a study presented at the 2019 American College of Rheumatology annual meeting in Atlanta, GA revealed opioid use hospitalizations have increased exponentially since the year 2000 across patients with 5 common rheumatic diseases, including rheumatoid arthritis(RA) and lower back pain(LBP).

“We believe our study might help our colleagues get insight into the time trends of OUD-hospitalizations,” said Jasvinder Singh, MD, MPH, professor at the University of Alabama at Birmingham, during a press conference at ACR 2019.

To further expound upon what investigators considered a limited amount of data on opioid use disorder (OUD)-related hospitalizations in people with musculoskeletal diseases, investigators sought to describe current rates of opioid abuse and associated mortality through a retrospective study using the US National Inpatient Sample(NIS) from 1998 to 2016. For the purpose of their analyses, investigators examined the rates of OUD hospitalizations without opioid overdose, detoxification, or rehabilitation services based on ICD-9 codes.

The 5 conditions chosen for evaluation by investigators were gout, RA, LBP, fibromyalgia, and osteoarthritis. Assessments of incidence OUD claims were assessed per 100,000 NIS claims overall.

Upon analyses, investigators noted increases in OUD-related hospitalizations across all 5 conditions examined to varying degrees. Investigators also noted hospitalizations OUD as the primary diagnosis were relatively low between 1998 and 2000 with only the rates for LBP (1.17) surpassing 1 per 100,000.

In regard to gout, the hospitalization rate per 100,000 in 1998 to 2000 was 0.05. In 2015 to 2016, that rate had jumped to 1.88—a 35-fold increase in 19 years. This was the largest percentage increase of all musculoskeletal conditions included in the study.

For patients with osteoarthritis, the rate of OUD-related hospitalizations was 0.68 per 100,000 in 1998 to 2000, but that number increased to 10.22 per 100,000 in 2015 to 2016. This represents a 14-fold increase.

Fibromyalgia patients experienced OUD-related hospitalizations at a rate of 0.53 per 100,000 in 1998 to 2000 and that number increased 12-fold by 2016 to 6.98 per 100,000. Investigators pointed out there was a plateau effect that occurred in regard to hospitalizations in fibromyalgia patients, with the rate per 100,000 peaking in the 2013 to 2014 time frame at 7.22 and decreasing to 6.98 in the 2015 to 2016 period.

Another condition that appeared to have a plateau effect ion the incidence of OUD-related hospitalizations was LBP. With a rate of 1.17 per 100,000 in the 1998 to 2000 time frame, investigators noted rate increases through until the 2011 to 2012 period when rates peak at 8.25 per 100,000. Subsequently, those rates drop to 7.43 per 100,00 from 2013 to 2014 and then increased again to 7.64 from 2015 to 2016.

For patients with RA, the rate per 100,000 in 1998 to 2000 was 0.30 and that number increased to 3.16 by the 2015 to 2016 time frame. Investigators pointed out these figure represent a 9-fold increase hospitalization rates.

Based on the results of their study, investigators suggested providers, policy makers, and patients with these conditions should all be cognizant of these trends to prevent additional OUD-associated hospitalizations.

This study, titled “Time-trends in Opioid Use Hospitalizations in Common Musculoskeletal Conditions: Gout, Osteoarthritis, Rheumatoid Arthritis, Fibromyalgia, and Low Back Pain,” was presented at ACR 2019 by Jasvinder Singh, MD, MPH.