Opioid Use in Systemic Lupus Erythematosus is on the Rise

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Nearly one third of patients with systemic lupus erythematosus use prescription opioids, with around two thirds of those using opioids for more than a year, while emergency department use is associated with increased prescription opioid use, say researchers writing in Morbidity and Mortality Weekly Report in Septmeber.

Sources of SLE-related pain can include active inflammatory disease resulting in peripheral pain, such as arthritis, damage accrual attributable to the disease or its treatment, or centralized pain disorders, such as fibromyalgia. Data on opioid use and associated outcomes in patients with rheumatic diseases are limited.

“Opioids are generally not indicated for pain in SLE and other rheumatic diseases because of limited efficacy and risks for addiction and adverse health effects,” wrote the authors, led by Emily Somers, Ph.D., of the University of Michigan in Ann Arbor.

This study compared 462 patients with SLE from an established Michigan cohort with 192 frequency-matched people without SLE. Data were collected through interviews conducted during February 2014–September 2015. Compared to participants without SLE, patients with SLE were more often female, unemployed, and more frequently reported emergency use, fibromyalgia, pain, poor physical function, depression, and anxiety.

During the study, 31 percent of patients with SLE were using prescription opioids, versus 8 percent of those without SLE (p<0.001). Among the SLE patients using opioids, 68 percent were using them for more than one year, and 22 percent were concomitantly on two or more opioid medications. SLE patients using the emergency department were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3–3.6; p = 0.004).

After accounting for demographic, psychosocial, and clinical factors, the odds of opioid use among SLE patients were three times higher than for those without SLE (OR = 3.4, 95% CI = 1.7–6.6; p <0.001). In analyses of the total study population and SLE patients, prescription opioid use was twice as likely among persons who had at least one emergency department visit in the last 12 months (total population: OR = 2.2, 95% CI 1.4–3.6, SLE patients only: OR = 2.1, 95% CI = 1.3–3.6). Pain and reduced physical functioning were also associated with opioid use when assessing the total population and SLE patients only; for each one standard deviation increase in pain and physical function scores, the odds of opioid use were approximately 35 percent and 12 percent higher, respectively.

“Risks for long-term opioid therapy, including osteoporosis and cardiovascular disease, are concerning in SLE patients given their increased underlying risks for these comorbidities. Strategies for reducing opioid use are needed in rheumatic disease populations. Clinicians managing SLE, including providers in emergency departments, need to be aware of these risks,” the authors wrote.

They added that the sources of pain in SLE, which are often multiple, persistent, and severe, must be accurately diagnosed to be appropriately treated.

“Effective interventions in this population will need to couple tailored approaches for tapering and discontinuing opioids when indicated, along with prevention of opioid initiation and consideration of nonopioid pain management strategies,” the authors wrote.

REFERENCE:  Emily C. Somers, Jiha Lee, Afton L. Hassett, et al. “Prescription Opioid Use in Patients With and Without Systemic Lupus Erythematosus - Michigan Lupus Epidemiology and Surveillance Program, 2014-2015.” MMWR Morb Mortal Wkly Rep.  September 27, 2019. doi: 10.15585/mmwr.mm6838a2.