Substance use disorder predicts long-term opioid use in psoriatic arthritis, axial SpA
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Key takeaways:
- In patients with axial SpA and PsA, long-term opioid use was higher among smokers and those with substance use disorder.
- Awareness of lifestyle factors could enable more tailored pain management.
Smoking, substance use disorder and taking gabapentinoids or antidepressants predict long-term opioid use among patients with axial spondyloarthritis and psoriatic arthritis, according to data published in Rheumatology.
“A high proportion of [rheumatic and musculoskeletal disease (RMD)] patients transition to long-term opioid use within 1 year following opioid initiation in the U.K.,” Yun-Ting Huang, PhD, MS, of the Center for Epidemiology Versus Arthritis, at the University of Manchester, in the United Kingdom, and colleagues wrote. “Long-term opioid use has been studied extensively but defined using varying definitions in the literature, and is associated with opioid dependence, abuse and harm.”
“Given the high frequency of long-term opioid use in [axial SpA (AxSpA)] and PsA, there is a pressing need to identify potential factors associated with long-term opioid use in this population using a rigorous approach, which can contribute to personalized treatment and help tailor targeted interventions,” they added.
To assess factors associated with long-term opioid use in patients with RMDs, Huang and colleagues analyzed data from the Clinical Practice Research Datalink Gold, a national U.K. primary care database. The data included 10,300 opioid initiations by 3,037 patients with axial SpA and 5,175 with PsA.
The main outcome, long-term opioid use, was defined as having three or more opioid prescriptions issued within 90 days, or a total of 90 or more days’ supply in the first year of follow-up, excluding the first 30 days. Associations between individual characteristics and long-term opioid use were assessed using a mixed-effects logistic regression model with patient-level random intercept.
According to the researchers, the following factors were associated with long-term opioid use:
- higher Charlson Comorbidity Index (OR = 3.61; 95% CI, 1.69-7.71);
- having a substance use disorder (OR = 2.34; 95% CI, 1.05-5.21);
- history of suicide/self-harm (OR = 1.84; 95% CI, 1.13-2.99);
- use of gabapentinoids (OR = 2.35; 95% CI, 1.75-3.16) or antidepressants (OR = 1.69; 95% CI, 1.45-1.98);
- being a current smoker (OR = 1.62; 95% CI, 1.38-1.9);
- co-existing fibromyalgia (OR = 1.62; 95% CI, 1.11-2.37); and
- high morphine milligram equivalents per day at initiation (OR = 1.03; 95% CI, 1.02-1.03).
The results “reflect the complexity of chronic pain management” but point to the significance of smoking and medication profiles in transitions to long-term opioid use, Huang and colleagues wrote.
“Awareness of one or more of these patient factors would allow the delivery of more tailored approaches for pain management in clinical practice, including non-pharmacological treatments, smoking cessation services and structured medication reviews,” they added. “This study highlights the importance of a comprehensive assessment, from health conditions and medication profiles to lifestyle habits for AxSpA/PsA, to help personalize treatment approaches and then promote safer prescribing and improve long-term patient outcomes.”
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