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High frequency of long-term opioid use among patients with rheumatic and musculoskeletal diseases initiating opioids for the first time
  1. Yun-Ting Huang1,
  2. David A Jenkins2,3,
  3. Niels Peek2,4,
  4. William G Dixon1,4,5,
  5. Meghna Jani1,4,5
  1. 1 Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
  2. 2 Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
  3. 3 NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
  4. 4 NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  5. 5 Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance, Salford, UK
  1. Correspondence to Dr Meghna Jani, Centre for Epidemiology Versus Arthritis, Stopford Building, The University of Manchester, Manchester, Manchester, UK; meghna.jani{at}

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People living with rheumatic and musculoskeletal diseases (RMDs) are frequently prescribed opioids to manage pain and represent a large subpopulation of patients at increased risk of long-term opioid use.1 A proportion of patients with RMDs newly prescribed an opioid will transition to long-term opioid use, which can be associated with opioid dependence, abuse and harm.2 Most studies define long-term opioid use as ≥90 days of use, but, the definitions in the literature vary considerably in frequency of use and duration.3 Variations in definitions can lead to challenges in characterising the scale of long-term opioid use, the opioid crisis and targeting the appropriate groups with the greatest benefit of interventions to improve safety.3 4 A more stringent definition would mean some might have missed opportunities to review, titrate or stop opioid therapy. A broader definition, however, would flag patients prescribed opioids intermittently or for acute episodes, and who might be at low risk of harm. Regardless, contemporary estimates of the scale of long-term opioid use remain unquantified in patients with RMDs. Our aim was to assess the proportion of patients transitioning to long-term opioid use in patients newly initiated on an opioid across six RMD conditions using varying definitions from the literature.

This study included patients aged ≥18 years registered in the Clinical Practice Research Datalink (CPRD) with a diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (AxSpA), systemic lupus erythematosus (SLE), osteoarthritis (OA) and fibromyalgia and without prior cancer. CPRD is a database of anonymised UK primary care electronic health records representative of the national …

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  • Handling editor Josef S Smolen

  • Twitter @joyce_huang_yt, @David_A_Jenkins, @NielsPeek, @WGDixon, @MeghnaJani

  • Contributors MJ and Y-TH conceived the study. MJ secured funding along with WGD, NP and DAJ. Y-TH led the data preparation and analysis and drafted the initial version of the manuscript. All authors contributed to the interpretation of the findings, critically reviewed the manuscript and contributed to revisions. All authors have read and approved the final manuscript.

  • Funding This work was funded by a FOREUM grant (grant ID: 125059) and NIHR grant (NIHR301413). MJ is funded through an NIHR Advanced Fellowship (NIHR301413). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The research is supported by the authors' institutions: Centre for Epidemiology Versus Arthritis (grant number 20380) and the NIHR Biomedical Reseach Centre (NIHR203308).The funder of this study had no role in study design, data collection, data analysis, data interpretation, writing of this article, or the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.