Background Opioid prescribing has contributed to a North American epidemic with increasing trends in several European countries1. Rheumatic and musculoskeletal diseases (RMDs) are one of the most common indications for prescribed opioids despite there being little evidence on opioid prescribing and the benefit of long-term use in RMDs.
Objectives To investigate national UK opioid prescribing trends by studying the patterns of opioid prescribing in new users with the following six RMDs: rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (AxSpA), systemic lupus erythematosus (SLE), osteoarthritis (OA) and fibromyalgia.
Methods Patients aged 18 years and older with a diagnosis of RA, PsA, AxSpA, SLE and OA with a new episode of opioid use without cancer in the Clinical Practice Research Datalink (CPRD) were included between 01/01/2006 and 31/12/2020. CPRD is a database of anonymised UK primary care electronic health records representative of the national population. New opioid users were defined as individuals with RMDs who had a new episode of opioid use in a 2-year time window up to 6 months before or after an RMD diagnosis. Rates of new opioid users were calculated by dividing the number of new opioid users with an RMD per year by the number of eligible patients registered in CPRD per year. Age- and gender-standardised rates for new opioid users were obtained using direct standardisation for each RMD. Rates of opioid prescriptions among new users for each RMD were calculated by dividing the number of opioid prescriptions among new users with an RMD in the year they had new opioid episodes by patient-years of the new users with an RMD. Trends for the rates in the study period were tested using negative binomial regression. Significant change points were identified by looking at the points where the derivative (i.e. rate of change) of the trends for the rates crossed zero. Recurrent opioid users were defined as patients who had at least 3 opioid prescriptions issued within 3 months after a new opioid episode.
Results This study included 21,505 RA patients, 8,392 PsA patients, 4,491 AxSpA patients, 4,508 SLE patients, 944,078 OA patients, and 33,829 fibromyalgia patients, who had new opioid episodes between 2006-2020. Whilst the overall trend for RA (2.7* vs 3.9*), PsA (1.0* vs 1.8*) and fibromyalgia (3.7* vs 8.3*) has significantly increased over 15 years, from 2018 onwards, trends of new opioid users appeared to stabilise/decrease (Figure 1). The year 2018 was found to be a significant decreasing change point in the trends of new opioid users for RA, AxSpA, and SLE, whilst this was 2013 in OA and 2019 for fibromyalgia. Opioid prescription rates among new opioid users increased in SLE (4.3# vs 5.4#), OA (4.6# vs 4.9#) and fibromyalgia (5.6# vs 6.5#) but decreased in RA (5.7# vs 5.3#) from 2006 to 2020, despite fluctuations in the rates observed in this period. The highest proportions of recurrent opioid users among the 6 RMDs were patients with RA (32.6%) and fibromyalgia (31.9%).
* The number of new opioid users per 10000 persons
# The number of opioid prescriptions in new users per patient years
Conclusion RA, PsA and fibromyalgia had an overall increase in new opioid users since 2006. The slight decrease in the trends of new opioid users among most of the RMDs after 2018 may reflect an increasing awareness of the opioid epidemic. The high proportions of recurrent opioid users in RA and fibromyalgia patients highlight the importance of exploring the safety of long-term opioid use and effective pain interventions for patients with RMDs.
References Jani M et al (2020) Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: A retrospective cohort study. PLoS Med 17(10): e1003270
Acknowledgements This work was funded by a FOREUM grant (grant ID: 125059), MJ is funded through an NIHR Advanced Fellowship (NIHR301413). Thanks to the CPRD fob holders in our centre, Ruth Costello and Ramiro Bravo, for downloading the data.
Disclosure of Interests Joyce (Yun-Ting) Huang: None declared, David Jenkins: None declared, Belay Birlie Yimer: None declared, Jose Benitez-Aurioles: None declared, Niels Peek: None declared, Mark Lunt: None declared, William Dixon Consultant of: WGD has received consultancy fees from Abbvie and Google., Meghna Jani: None declared.
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