Longitudinal opioid prescribing patterns suggest that regular use among rheumatoid arthritis (RA) patients is slightly declining, according to a study published in Arthritis & Rheumatology.

Researchers from the University of Alabama, Birmingham, analyzed Medicare data from 2006–2014 for trends of regular opioid use, defined as ≥3 filled prescriptions for every 12-month period. Overall, 70,929 patients met the criteria for evaluation.

Results showed that opioid use slowly rose from 2006, peaked in 2010, then slowly decreased. Forty percent of RA patients were considered regular opioid users. Nearly half had at least some opioid prescriptions written by a rheumatologist; 14% of users were co-prescribed opioids by more than one physician.

In 2010, the second most commonly used opioid propoxyphene was removed from the U.S. market. However, the researchers suggest that this had minimal impact on the decline as patients switched to other opioids, particularly hydrocodone and tramadol. Use of hydrocodone initially rose in 2010 then decreased, which may have been due to higher dose acetaminophen-containing products being slowly phased out between 2011 and 2014. Use of tramadol, a weaker opioid with a more favorable risk-benefit profile, was found to increase over time.

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Younger age, female sex, black race, back pain, fibromyalgia, anxiety, and depression were all factors associated with regular opioid use.

The authors wrote that this association “invites a concern that some patients likely received opioids when other interventions may have been more appropriate.” They also concluded that the results imply substantial use of opioids in older RA patients, which has been of particular focus in recent years.

Trials that examine opioid treatments for RA have generally been shorter and modest in size, similar to studies for non-pharmacologic interventions. Because of this, “rheumatologists and other clinicians caring for patients with RA face a significant dilemma precisely because the options for care of pain remain problematic.”

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