Long-term opioid use is more common among patients with rheumatic and musculoskeletal disorders

Patients with rheumatoid arthritis and musculoskeletal disorders are vulnerable to long-term opioid use, and up to 1 in 3 patients with rheumatoid arthritis and fibromyalgia who are new to these drugs potentially at risk, the findings of the research letter suggest.published online A chronicle of rheumatic diseases.

People with rheumatoid arthritis and musculoskeletal disorders are often prescribed opioids to manage pain, some of whom become long-term users at risk of dependence and adverse side effects, the authors note. do.

Most studies defined long-term opioid use as ≥90 days, but definitions varied, and current estimates of the magnitude of long-term opioid use were not available, he added.

To assess the proportion of newly started opioid patients who transition to long-term use, researchers entered details into the UK’s leading Clinical Practice Research Data Link (CPRD). We used the anonymized medical records of 841,047 adults. Primary Care Research Database.

Approximately 12,260 were diagnosed with rheumatoid arthritis, 5,195 with psoriatic arthritis, 3,046 with axial spondyloarthritis, 3,081 with systemic lupus erythematosus (SLE), 796,276 with osteoarthritis, and 21,189 with fibromyalgia It had been.

Each patient was newly prescribed opioids 6 months before or at any time after diagnosis from January 2006 to the end of October 2021 and was monitored for at least 1 year.

Long-term use was defined as either standard (≥3 opioid prescriptions issued within 90 days or >90 days of opioid supply in the first year). or strict (requiring ≥10 opioid prescriptions over 90 days or ≥120 days of opioid supply in the first year). or extensive (3 or more opioid prescriptions per month for the first 12 months).

A total of 1,081,216 new opioid uses were identified in all patients, of which just under 17% transitioned to long-term use based on standard use, 11% to strict use, and 22% to broad use.

Most (97%+) new prescription episodes meeting either definition were captured by the broad definition. Just under half completed all three.

The highest proportion of long-term opioid users are those with fibromyalgia, defined respectively, at 27.5%, 21%, and 34%, followed by those with rheumatoid arthritis (26%, 18.5%, and 32%), and patient followed. Axial spondyloarthritis – 24%, 17%, 30%.

The lowest rates of migrators were in patients with osteoarthritis, at 16.5%, 11% and 21.5%, respectively.

The proportion of people with SLE and fibromyalgia who became long-term opioid users increased significantly from 2006 to 2019, rising from 22% to 33% and reaching 29% in 2020.

Although a statistically significant downward trend was observed in rheumatoid arthritis patients, the overall rate remained high at 24.5% in 2020.

Under the strict definition, 1 in 5 people with fibromyalgia and 1 in 6 people with rheumatoid arthritis or axial spondyloarthritis met the definition of long-term opioid use within 12 months of opioid initiation. .

But that rate could be as high as 1 in 3 people with broad fibromyalgia and rheumatoid arthritis, and as high as 1 in 3.5 people with axial spondyloarthritis, researchers say.

“The findings justify caution in opioid prescribing practice.” [rheumatoid and musculoskeletal conditions] Long-term opioid therapy is associated with poor outcomes (eg, opioid dependence and opioid-related adverse events),” they warn.

And they encourage clinicians to review or discontinue medications and consider nonpharmacologic pain relief to minimize the risk of “inevitable harm” in this group of patients. I am advising you.