Opioid Prescriptions Nearly 3 Times More Likely in Patients with Rheumatic, Autoimmune Diseases

Results of a new study are providing insight into changes in opioid prescribing practices for patients with systemic autoimmune or inflammatory rheumatic diseases.

An analysis of data from the National Ambulatory Medical Care Survey recorded between 2006 and 2019, results of the study indicate patients with systemic autoimmune or inflammatory rheumatic diseases were nearly 3 times as likely to receive a prescription for opioids as their counterparts without such conditions during the study period.¹

“To our knowledge, the current study is the largest to explore opioid prescribing in the [Systemic Autoimmune/Inflammatory Rheumatic Diseases] population at the national level across different payers; in addition, it uses more recent data up until 2019,” wrote investigators.¹

Few health crises have gripped the attention of public health circles as well as the US general public in the same manner as the opioid epidemic. According to the National Institute of Drug Abuse, mortality involving prescription opioids rose from 3442 in 1999 to 17,029 in 2017. However, as policy reform and other structural changes came forth to address this growing issue, the community has begun to see progress, which resulted in a decline in instances involving prescription opioids to 14,139 from 2017 to 2019.²

In the current study, a team of investigators led by Yinan Huang, MS, PhD, of the Department of Pharmacy Administration at the School of Pharmacy at University of Mississippi, sought to describe how opioid prescribing may have differed among patients with systemic autoimmune or inflammatory rheumatic diseases or without from 2006 through 2019. With this in mind, investigators designed as a cross-sectional study of data recorded from ambulatory visits with adult patients from the National Ambulatory Medical Care Survey between 2006 and 2019.¹

The primary outcome of interest for the study was differences in opioid prescribing between those with and without systemic autoimmune or inflammatory rheumatic diseases, which investigators pointed out was assessed using multivariable logistic regression accounting for the complex survey design and adjusting for predisposing, enabling, and need factors within Andersen's Behavioral Model of Health Services Use. Investigators used predictors associated with opioid prescribing in patients with systemic autoimmune or inflammatory rheumatic diseases as a secondary outcome of interest.¹

During the period of interest, the average number of visits for patients with systemic autoimmune or inflammatory rheumatic diseases was 5.2 (95% Confidence Interval [CI], 3.58 to 6.82) million and 780.14 (95% CI, 747.56 to 812.72). Upon analysis, results indicated those with systemic autoimmune or inflammatory rheumatic diseases where more likely to be prescribed opioids than their counterparts without systemic autoimmune or inflammatory rheumatic diseases (22.53% vs 9.83%; adjusted odds ratio [aOR], 2.65; 95% CI, 1.68 to 4.18).¹

Analysis of predictors revealed being aged 50 to 64 years (vs 18 to 49 years: aOR, 1.95; 95% CI, 1.05 to 3.65) and prescribing of glucocorticoids (aOR, 1.75; 95% CI, 1.20 to 2.54) were associated with increased likelihood of opioid prescribing among those with systemic autoimmune or inflammatory rheumatic diseases. In contrast, having private insurance was linked to reduced likelihood of opioid prescribing relative to Medicare (aOR, 0.50; 95% CI, 0.31 to 0.82).¹

“In light of limited data about the efficacy of chronic opioid use in SARDs and potential adverse effects, the current data warrant vigilance from rheumatologists in prescribing opioids for SARDs patients,” investigators wrote.¹ “Non-opioid alternatives for pain management should also be considered. There is also a need to optimize the use of the disease-modifying antirheumatic drugs.”

References:

1. _{^{Huang Y, Bruera S, Agarwal SK, et al. Opioid Use for Adults with and without Systemic Autoimmune/Inflammatory Rheumatic Diseases: Analysis of 2006-2019 United States National Data. Arthritis Care Res (Hoboken). Published online May 20, 2024. doi:10.1002/acr.25378}}