High Rates of Chronic Opioid Use Persist in Older Patients With RA

Despite a small decline in chronic opioid use after 2010, recent research suggests that 40% of older patients with rheumatoid arthritis (RA) still take opioids regularly as of 2014, published in Arthritis & Rheumatology (published online June 21, 2017; doi:10.1002/art.40152).


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Opioid prescribing in recent years has been a prominent concern in health care. However, longitudinal patterns of opioid prescription in a population-based cohort of patients with chronic pain, such as those with RA, have yet to occur.

Jeffrey R Curtis, MD, MS, MPH, director, Arthritis Clinical Intervention Program, University of Alabama at Birmingham, and colleagues conducted a study to evaluate longitudinal time trends in regular opioid use among older patients with RA. Researchers identified 70,929 patients who met eligibility requirements for a time-trend analysis (2006 to2014). Regular opioid use was defined as having at least three filled prescriptions filled in each 12-month interval or one or more prescriptions filled for a 90-day supply.

Researchers found that hydrocodone and propoxyphene were the most commonly received opioids. Regular opioid receipt increased until 2010, followed by a slight and gradual decrease after the removal of propoxyphene from the market. Nonetheless, the withdrawal of propoxyphene had minimal effect on overall opioid use, as the drug was replaced with greater use of other opioids.

A second analysis using only patient data from 2014 found variability among United States rheumatologists (n = 4024) in prescribing regular opioids for patients with RA to be high (ranging from 0% to 93%). Approximately 40% of patients were found to use prescribed opioids regularly. Close to half of the patients had at least some opioid prescriptions written by a rheumatologist, and 14% were co-prescribed opioids concurrently by more than one physician.

Dr Curtis and colleagues concluded that while the results of their study suggest that use of opioids in older patients with RA appears to still be substantial, rheumatologists caring for this patients face a dilemma “precisely because the options for care of pain remain problematic.”

The findings suggest further needs for individualized care and increased efforts to create effective pain interventions for patients with RA, they concluded.—Zachary Bessette