Chronic Opioid Use in Rheumatoid Arthritis: Prevalence and Predictors

Abstract

Objective. The opioid epidemic is a major public health concern. However, little is known about opioid use among rheumatoid arthritis (RA) patients. We undertook this study 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. Opioid use was ascertained from surveys obtained at clinical visits as often as every 3 months. Chronic opioid use was defined as any opioid use reported during ≥2 consecutive study visits. Annual prevalence of chronic opioid use was calculated using data from 33,739 RA patients with information on opioid use from ≥2 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. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated.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, whereas 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.

Different aspects of opioid use in rheumatoid arthritis patients

“…In a cohort study conducted in the US in 2002-2015, the criterion of chronic opioid use was defined on the basis of documented opioid use during at least two follow-up visits, with the median time between two visits being 156 days. In the study group, the percentage of chronic opioid users more than doubled from 7.4 in 2002 to 16.9 in 2015 21 . Another study found that patients with RA in 2014 were 1.5 times more likely to use opioids than those without RA (40 % vs 24%) and were almost twice as likely to use opioids chronically (12% in RA vs 4% in non-RA patients, the rate index was adjusted for age and gender), with the study assuming that chronic opioid use was considered to be providing the patient with a prescription for 60 days or longer 3 .…”

“…The cohort studies also highlighted the medications that RA patients used concomitantly with chronic opioids. In one of the studies slightly more than 40% of respondents took biological DMARDs, 27% took glucocorticosteroids and almost 18% took antidepressants 21 . To this list other studies add the frequent use of benzodiazepines, antiepileptic drugs 26 and the use of non-opioid analgesics such as acetaminophen or NSAIDs 28 .…”

“…The observed relationship between the use of opioids and biological drugs and glucocorticosteroids may result from the fact that people who require biological treatment are characterized by greater disease activity and greater pain intensity 21 . On the other hand, it seems that the low level of parameters and symptoms of inflammation does not equal reduced pain and fatigue 6 .…”

“…The increase of opioid use has been observed worldwide, but it is particularly dramatic in the United States, where prescription sales quadrupled between 1999 and 2010 34 , reaching 38% of American adults taking opioids in 2015, and 17% of these reported disorders related to opioid use 21 , including increasing dependence and opioid abuse 15 . The death rates caused by opioid poisoning also more than doubled between 2000 and 2013, with 81% of these deaths being unintentional 3 .…”

“…Data on the use of opioids in chronic pain are similarly disturbing -it is believed that 21-29% of patients have abused them 14 . Compared to other drugs for chronic pain, opioids have a significantly increased risk of death from overdose 21 . In Poland, in the years 2000-2015, there was a threefold increase in the use of opioid analgesics; there was an increase in the use of both weak and strong opioids, and almost 93% of them were prescription for ambulatory use.…”