Opioid Prescription Rates for OA Remained Stable Despite Increased Awareness of Risks

John R.P. Tesser, MD

This retrospective analysis from a Humana database identified more than 3.5 million patients with OA from 2007 to 2014. Researchers found 11.5% of patients with OA per year received an opioid prescription. More prescriptions were written for OA of any joint over OA of the knee or hip, and OA of the knee over OA of the hip. Also, patients who received more prescriptions were patients younger than 49 years and more men than women for all OA groups. In addition, more prescriptions were written in the South than in the Northeast regions of the United States.

In the context of the current opioid epidemic, one might think the numbers of prescriptions and, hence, the percentage of patients receiving the prescriptions might be in decline. The authors point out evidence that indicates opioid use before, during and after surgery has been associated with worse outcomes and ongoing opioid use. However, patients with more severe symptomatic OA may pre-select for both preoperative and postoperative opioid use and thereby have worse surgical outcomes.

A few methodologic issues should be mentioned. The quantity and strength of the opioid was not identified in the chart reviews nor could they identify if the patients took the narcotic medication or how much of the prescription they took. Also, we don’t know if the patients had contraindications to NSAIDs, Tylenol or other therapies and/or if they had failed these therapies. Some of the more recent evidence related to the harms and lack of benefit of opioids was published late into the study period and may not have diffused into the general knowledge of the prescribers at the cutoff date of the analysis, which was 2014. One contrarian view to consider is that opioid medication may be the best alternative for a small cadre of patients if selected properly. How to identify potentially proper candidates remains a challenge.

Overall, the results act as a baseline from which future analyses can be compared. The authors note that perhaps future guidelines and strategies will be developed to reduce opioid prescribing. They also note that health care providers struggle with alternative treatments for chronic OA pain. So, the burning issue that confronts all of us is the need for different, more effective and safer alternative analgesic medications or interventions that will offer truly better treatments for patients with OA.