Chronic Opioid Use Observed Among Patients With Knee Osteoarthritis

close up of a group of white tablets with an out of focus prescription bottle in the background
Researchers assessed the prevalence and risk factors for opioid use in patients with knee osteoarthritis.

The prevalence and risk factors for opioid use were identified among patients with knee osteoarthritis (OA), with approximately 10% of patients reporting chronic opioid use and 21% reporting occasional opioid use, according to study results published in Arthritis Care & Research.  

Current rheumatology guidelines, including those by the American College of Rheumatology (ACR), recommend against opioids for pain management in knee OA; however, research shows that opioids are still widely being prescribed.

To better examine the trends in OA-related opioid use, researchers used data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative sample of Medicare enrollees. They used data from 2003, 2006, 2009, 2011, 2013, 2015, and 2016. Eligible patients had diagnostic and procedural codes for knee OA during the selected survey years. Demographic and clinical characteristics were collected by self-report and from claims records.

The primary outcome was opioid use, which was determined through prescription records. Three outcome categories were established: nonusers (0 opioid prescriptions per year); occasional users (1-5 prescriptions per year); and chronic users (6 or more prescriptions per year).

Multivariable logistic regression was used to identify correlates of chronic opioid use. Models were adjusted for demographic and clinical factors, including medical comorbidities.

The study cohort included 3549 Medicare beneficiaries with knee OA, contributing to 1 or more survey year. Mean patient age was 78±7 years; 68% were women; and 93% were non-Hispanic. The majority of patients (78%) had at least 1 comorbid condition.

Overall, 9% of patients were identified as having chronic opioid use and 21% reported occasional opioid use. The percentage of survey respondents with any opioid use increased from 27% to 39% between 2003 and 2013, then decreased to 19% by the end of 2016.

Based on the regression models, non-Hispanic vs Hispanic patients (odds ratio [OR], 4.8; 95% CI, 2.2-10.2) were more likely to experience chronic opioid use. Further, patients who were divorced from their partners (OR, 2.3; 95% CI, 1.5-3.5), patients living in nonmetropolitan areas (OR, 1.8; 95% CI, 1.3-2.4), patients with low educational attainment (OR, 1.4; 95% CI, 1.0-1.9), and patients who were eligible for Medicaid (OR, 1.9; 95% CI, 1.3-2.7) were more likely to report chronic opioid use vs no opioid use. Medical conditions associated with increased chronic use risk included depression (OR, 1.9; 95% CI, 1.5-2.5), chronic obstructive pulmonary disease (COPD; OR, 1.9; 95% CI, 1.4-2.5), and inability to walk without assistive devices (OR, 2.4; 95% CI, 1.5-.37).

Study limitations included the cross-sectional design and use of claims data to identify OA, which may have led to certain misspecifications.

“Finding alternative pain management treatments for [a]t-risk patients prior to surgery could lead to better outcomes and lower likelihoods of future opioid overuse, and could reduce the effect that knee OA-related opioid prescriptions have on the national opioid epidemic,” the researchers concluded.


Losina E, Song S, Bensen GP, Katz JN. Opioid use among Medicare beneficiaries with knee osteoarthritis: prevalence and correlates of chronic use. Arthritis Care Res (Hoboken). Published online December 17, 2021. doi:10.1002/acr.24844