These were the findings of a study titled “Changing Patterns over Time in Opiate Use in U.S. Rheumatoid Arthritis Patients,” recently presented at the American College of Rheumatology Annual Meeting in San Diego.
“Opioid use has come under increasing scrutiny with concerns both that we might be overprescribing and that underuse is an unintended consequence,” Jeffrey Curtis, MD, MPH, from the division of clinical immunology and rheumatology at the University of Alabama at Birmingham, said in his presentation, according to a news release.
Curtis and colleagues used national Medicare data to characterize trends over time as well as variability in opiate prescribing practices over the short and long term. They identified 73,834 RA patients meeting eligibility criteria who were diagnosed with RA between 2006 and 2014. Their mean age was 67.6, and 80 percent were female.
Patients must have had at least six consecutive observable months before Jan. 1, 2007, and oral opiate use (one or more filled prescriptions) was assessed every six months for patients who remained under follow-up over each six-month interval.
In 2006, the most commonly used opiates were medications that combined acetaminophen with hydrocodone or with propoxyphene (withdrawn from U.S. use in 2010), the researchers found. Between 2006-2014, overall opiate use increased slowly but significantly and reached a peak in 2010, decreasing after that.
Following the U.S. withdrawal of propoxyphene in 2010, use of hydrocodone and tramadol increased. Factors associated with opiate use included younger age, female, white ethnicity, disability, lower income, and baseline nonsteroidal anti-inflammatory drug (NSAID) use.
In 2014, the researchers found there was high variability in opiate use. For rheumatology practices at the 50th percentile of opiate use, 46 percent of RA patients used opiates.
The results also showed that opiate use was 0 percent at the first percentile, 37 percent at the 25th percentile, 55 percent at the 75th percentile, and 92 percent at the 99th percentile.
Among all patients in the analysis, 43 percent of RA patients were prescribed opiates by a rheumatologist.
“Guidelines on appropriate use in patient populations like those we see with RA or other pain syndromes may be useful to potentially reduce inappropriate prescribing,” Curtis said.