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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 …
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.
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