Opioid risk for patients with pain conditions

The risk of long-term opioid use is increased among people with rheumatoid arthritis or fibromyalgia, a new study has found.

Dr Meghna Jani of the University of Manchester, UK, and colleagues report their study in Annals of the Rheumatic Disease today.

The team analysed medical records of 841,047 adults on the UK’s Clinical Practice Research Datalink. All had been newly prescribed an opioid for a pain condition.

Around 17% of opioid prescriptions led to long term use. The rate was highest for those with fibromyalgia, with around a quarter of prescriptions leading to long term use.

Those with rheumatoid arthritis or axial spondyloarthritis were also at a high rate of risk.

Analysis showed that the proportion of patients who developed long term opioid use increased from 22% in 2006 to 33% in 2019. However, the rate fell slightly for patients with rheumatoid arthritis.

The authors calculate that one in five fibromyalgia patients and one in six rheumatoid arthritis or axial spondyloarthritis patients developed long term opioid use within a year, using a fairly strict definition.

They write: “The findings warrant vigilance in practice of opioid prescribing for [rheumatoid and musculoskeletal conditions] since long term opioid therapy is associated with poor outcomes (eg, opioid dependence and opioid-related adverse events).”

They call on clinicians to carry out medication reviews and consider non-drug treatments for pain relief when possible.

Huang, Y. T. et al. Letter: High frequency of long-term opioid use among patients with rheumatic and musculoskeletal diseases initiating opioids for the first time. Annals of the Rheumatic Disease 17 May 2023; doi: 10.1136/ard-2023-224118


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