Increased Opioid Prescribing Linked to Chronic Usage in Patients With RA

A physician's baseline opioid prescribing rate was a strong predictor of a patient's future opioid use.

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO — Prescribing opioids for individuals with rheumatoid arthritis (RA) has shown large variation among physicians, but a patient’s future opioid addiction was predicted by their physician’s baseline rate of opioid prescribing. This research was recently presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, 2018, in Chicago, Illinois.

This study included 148 physicians, whose baseline rates of opioid prescribing ranged from 0% to 70% (median 27%), as well as 9337 patients with RA. Chronic opioid use in patients was significantly linked to the baseline rates of physician opioid prescribing. The odds ratio for chronic opioid use according to physician prescribing rate was 1.16 in the second quartile (95% CI, 0.79-1.70). In addition, the odds ratio of the third quartile was 1.89 (95% CI, 1.27-2.82), and the odds ratio of the fourth and highest quartile was 2.01 (95% CI, 1.43-2.83). Subgroups did not show any statistically significant variations.

Researchers used the Corrona Rheumatoid Arthritis Registry to collect data for this study. Physicians who had contributed fewer than 10 patients with RA in their first year in the registry were excluded from the study. Inclusion criteria for patients included seeing one of the study’s selected physicians, having at least 1 year of follow-up, and not using opioids at baseline.

To calculate the baseline rates of opioid prescribing, the number of patients who used opioids was divided by the total number the doctor saw within the year. The association between the rate of opioid prescribing and future opioid addiction was investigated using generalized linear mixed models adjusted for relevant characteristics of patients, physicians, and sites. To assess heterogeneity across disease activity, intensity of pain, and use of antidepressants, researchers performed subgroup analyses and assessed differences using interaction terms.

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The study researchers conclude that “rates of baseline opioid prescribing varied widely. A physician’s baseline opioid prescribing rate was a strong predictor of whether a patient would become a chronic opioid user in the future, even after controlling for patient characteristics.”

Please refer to abstract for a complete list of author disclosures.

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Lee YC, Lu B, Guan H, Greenberg J, Kremer J, Solomon D. Physician opioid prescribing patterns and risk for chronic opioid use among rheumatoid arthritis patients. Presented at: 2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 1917.

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This article originally appeared on Rheumatology Advisor