Although the rates of opioid prescriptions to patients with osteoarthritis (OA) remained stable between 2008 and 2017, there was an increase in prescription rates of fentanyl and oxycodone, according to study results published in Rheumatology.

In this population-based cohort study, prescription information for the 2008 to 2017 period was gathered using the Integrated Primary Care Information database, which included electronic medical records data of >1.5 million patients in the Netherlands. Patients aged ≥30 years with incident OA and without malignancy or neuropathic pain disorders were included in the study. Demographic and clinical data were also collected.

The primary outcome of the study was receipt of any opioid prescription between 2008 and 2017. Opioid prescribing incidence was calculated by dividing the total number of new prescription episodes (absence of an opioid prescription in the previous 6 months) by the total number of person-years per calendar year, and the opioid prescribing prevalence was calculated by dividing the total number of patients with ≥1 prescription by the total number of person-years in a calendar year. Long-term opioid use (receipt of ≥6 opioid prescriptions in 1 year) was also assessed. Logistic regression was performed to identify baseline predictors of opioid prescriptions.

Data from 157,904 patients (mean age, 66.6±12.5 years; 65.2% women) with OA were included in analyses, 56,713 of whom were newly diagnosed. In this cohort, 16.4% of patients were prescribed a weak opioid, 5.1% a strong opioid, and 4.6% a combination of both.


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Long-term opioid use was observed in 3% of patients with incident OA. The overall prescription rate remained stable over 10 years, at approximately 100 incident and 170 prevalent prescriptions per 1000 person-years. An increase in incident prescribing was observed for oxycodone, which increased from 7.1 to 40.7 per 1000 person-years, and for fentanyl, which increased from 4.2 to 7.4 prescriptions per 1000 person-years between 2008 and 2017, respectively. The prescribing incidence of tramadol/paracetamol and paracetamol/codeine was found to decrease during that time period.

Patients with OA in ≥2 joint groups (odds ratio [OR], 1.56; 95% CI, 1.51-1.65), with other musculoskeletal disorders (OR, 4.91; 95% CI, 4.76-5.05), and who were older were found to be associated with a greater number of opioid prescriptions in multivariate analyses. Men were less likely to receive opioid prescriptions than women (OR, 0.78; 95% CI, 0.76-0.80).

Study limitations included the fact that the indication for opioid prescriptions could not be directly verified using medical records and that participants may have used prescription opioids to manage other disorders.

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“Since the benefit of opioids for OA pain is questionable and side effects are common, opioids should be prescribed with caution,” the investigators noted.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures

Reference

van den Driest JJ, Schiphof D, de Wilde M, Bindels PJE, van der Lei J, Bierma-Zeinstra SMA. Opioid prescriptions in patients with osteoarthritis: a population-based cohort study [published online January 20, 2020]. Rheumatology. doi:10.1093/rheumatology/kez646