Nearly one-quarter of all SARDs outpatient visits in US result in opioid prescription
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Key takeaways:
- A total of 22.53% of all visits by adults with SARDs between 2006 and 2019 resulted in opioid prescriptions.
- Older adults with SARDs had nearly twice the chance of being prescribed opioids as younger adults.
Nearly one-quarter of outpatient visits by patients with systemic autoimmune rheumatic diseases in the United States between 2006 and 2019 resulted in an opioid prescription, according to data published in Arthritis Care & Research.
“There is limited data concerning the effectiveness of opioids for the chronic non-cancer pain experienced by patients with [systemic autoimmune rheumatic/inflammatory diseases (SARDs)],” Yinan Huang, MS, PhD, assistant professor of pharmacy administration at the University of Mississippi, and colleagues wrote.
“In addition, several studies have reported an increased risk of adverse events, such as hospitalizations, falls and fractures, associated with the use of opioids for musculoskeletal pain in SARDs population,” they added. “Therefore, it is important to understand the patterns related to opioid use among individuals with SARDs.”
To compare opioid prescribing patterns for ambulatory visits among patients with SARDs to those without, Huang and colleagues conducted a cross-sectional study of the National Ambulatory Medical Care Survey (NAMCS), examining a nationally representative sample of office-based care visits between 2006 and 2019. According to the researchers, the NAMCS database includes a series of annual surveys of outpatient visits in the United States, administered by the CDC National Center for Health Statistics.
Using multivariable logistic regression, the researchers compared opioid prescription among adults without SARDs vs. adults with SARDs, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus. The primary outcome was a prescription for opioids during a visit. Opioids were classified as either analgesics (eg, codeine, fentanyl and hydrocodone) or analgesic combinations (eg, codeine-based or hydrocodone-based).
According to the researchers, a total of 22.53% of all visits by adults with SARDs resulted in an opioid prescription, or an estimated 1.17 million (95% CI, 0.49-1.86 million) annually. Patients with SARDs were more likely to be prescribed opioids (adjusted OR = 2.65; 95% CI, 1.68-4.18), compared with those without SARDs.
In addition, compared with patients with SARDs aged 18 to 49 years, those aged 50 to 64 years demonstrated almost double the chance of being prescribed opioids (aOR = 1.95; 95% CI, 1.05-3.65). Prescription of glucocorticoids increased the odds of opioid prescription (adjusted OR = 1.75; 95% CI, 1.2-2.54), while having private insurance, vs. Medicare, decreased the odds (adjusted OR = 0.5; 95% CI, 0.31-0.82).
“In light of limited data about the efficacy of chronic opioid use in SARDs and potential adverse effects, the current data warrant vigilance from rheumatologists in prescribing opioids for SARDs patients,” Huang and colleagues wrote. “Non-opioid alternatives for pain management should also be considered.
“There is also a need to optimize the use of the disease-modifying antirheumatic drugs,” they added. “While future research should evaluate the clinical consequences of opioid use in patients with SARDs, understanding the effectiveness of DMARDs in opioid tapering or de-prescribing may be helpful in addressing the growing opioid utilization in the SARDs population.”
Perspective
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Daniel J. Wallace, MD, FACP, MACR
This study suggests that one-quarter of patient visits for inflammatory arthritis, over a period of time, resulted in prescribed opioids. It should be noted that these agents have not been demonstrated to be disease modifying, are addicting, and can do more harm than good. I would consider this a wake-up call for musculoskeletal specialists to do everything in their power to decrease this percentage. Unfortunately, this article raises more questions than it answers.
The paper tracks prescriptions since 2006. Is there a trend? Have the percentages increased or decreased over time?
Did this include patients receiving more than a single prescription? For example, a patient with rheumatoid arthritis given hydrocodone for a short time after orthopedic surgery is not in the same ballpark as a patient with RA on chronic hydrocodone.
Since CPT codes were available for all patients, how many had fibromyalgia, and did this diagnosis influence the use of opioids?
Did the percentage differ comparing rheumatologist-prescribed opioids vs. non-rheumatologist prescribed opioids? The authors refer to the role of rheumatologist vigilance but provide no information on this.
In summary, the use of opioids is too high, but the paper does not help us to approach the problem and give us no guidelines of where to start.
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