How Has Opioid Use Changed Across the Rheumatoid Arthritis Landscape?

Opioid use among older Americans with rheumatoid arthritis (RA) peaked in 2010, but is now on a slight decline, according to a study published in Arthritis & Rheumatology.

The opioid crisis is a major concern worldwide, with overdoses accounting for the number 1 cause of accidental deaths in the United States.

Despite the epidemic catching the attention of health care professionals and the general population alike, longitudinal patterns of opioid prescription receipt in a population-based cohort of patients with RA has not been well characterized, according to the study authors.

Based on Medicare data from 2006 to 2014, investigators identified a cohort of patients with RA to evaluate longitudinal time trends in regular opioid use. Regular use was defined as more than 3 filled prescriptions in each 12-month interval.

A separate analysis in 2014 assessed rheumatologist-specific variability in regular opioid prescriptions for patients with RA.

Overall, 70,929 patients with RA met eligibility criteria, with a mean age of 67.4 years. The most commonly prescribed opioids were hydrocodone and propoxyphene.

The results of the analysis showed that regular opioid receipt slowly increased, peaked in 2010, and decreased following the withdrawal of propoxyphene.

The FDA withdrew propoxyphene from the market because of a link to a potentially deadly heart rhythm abnormality, even when the painkiller was taken at recommended doses.

Receipt of hydrocodone and tramadol increased commensurately, according to the study. Overall opioid use only declined slightly.

“In the US, opioid use peaked in older RA patients in 2010 and is now declining slightly,” the authors concluded. “Withdrawal of propoxyphene from the US market in 2010 had minimal effect on overall use, as it was replaced with greater use of other opioids.”