(C) Trends in Opioid New Users and Subsequent Long-Term Use Among Patients with Rheumatic and Musculoskeletal Diseases Between 2006-2020

Publication Number: 293

Background: Opioid prescribing has contributed to a North American epidemic with increasing trends in several European countries. Rheumatic and musculoskeletal diseases (RMDs) are one of the most common indications for prescribed opioids despite little evidence on opioid prescribing and the benefit of long-term use in RMDs.

Objectives: To investigate national UK opioid prescribing trends in new users with the six RMDs: rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (AxSpA), systemic lupus erythematosus (SLE), osteoarthritis (OA) and fibromyalgia.

Methods: Patients aged 18+ years with RMDs with a new episode of opioid use without cancer in the Clinical Practice Research Datalink (CPRD) were included between 01/01/2006 and 31/12/2020. CPRD is a database of anonymised UK primary care electronic health records representative of the national population. Age- and gender-standardised rates of new opioid users were obtained by dividing the number of new opioid users with an RMD per year by the number of eligible patients registered in CPRD per year and using direct standardisation. Trends for the rates were tested using negative binomial regression. Significant change points were identified by looking at the points where the derivative (i.e. rate of change) of the trends for the rates crossed zero. Long-term opioid users were defined as patients who had 3+ opioid prescriptions issued within a 90-day period, or 90+ days opioid supply, in the first year of follow-up, not including the first 30 days after a new opioid episode.

Results: This study included 21505 RA patients, 8392 PsA patients, 4491 AxSpA patients, 4508 SLE patients, 944078 OA patients, and 33829 fibromyalgia patients, who had new opioid episodes between 2006-2020. Whilst overall trends for RA (2.7* vs 3.9*), PsA (1.0* vs 1.8*) and fibromyalgia (3.7* vs 8.3*) has significantly increased over 15 years, from 2018 onwards, trends of new opioid users appeared to stabilise/decrease. The year 2018 was a significant decreasing change point in the trends of new opioid users for RA, AxSpA, and SLE, whilst this was 2013 in OA and 2019 in fibromyalgia. The highest proportion of long-term opioid users was fibromyalgia patients (41.2 %), followed by RA (36.2%), AxSpA (31.5%), PsA (28.1%), SLE (25.5%) and OA (19.7%).
* Number of new opioid users per 10000 persons

Conclusions: RA, PsA and fibromyalgia had an overall increase in new opioid users since 2006. The slight decrease in the trends of new opioid users among RMDs after 2018 may reflect an increasing awareness of the opioid epidemic. The high proportions of long-term opioid users in RMDs highlight the importance of exploring the safety of long-term opioid use and effective pain interventions for RMDs.