Opioid Use in Osteoarthritis Is Largely Affected by Geography
The percentage of individuals with advanced osteoarthritis receiving opioids as long-term treatment varies greatly from state to state, according to a new study.1
"These findings suggest that regional prescribing practices are key determinants of prescription opioid use in chronic pain patients, and geographically targeted dissemination strategies for safe opioid prescribing guidelines may be required to address the high use observed in certain states," said Rishi J Desai, MS, PhD, study co-author.2
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To evaluate the variation in long-term opioid in osteoarthritis—and how geography and health care access affect it—Desai and colleagues analyzed data on 358,121 participants from 4080 primary care service areas who had advanced osteoarthritis and underwent total joint replacement between 2010 and 2014.
Long-term opioid use was defined as having taken the therapy for 90 or more days in the year immediately preceding total joint replacement.
The percentage of long-term opioid users varied greatly among the states—from 8.9% of patients in Minnesota to 26.4% of patients in Alabama. This variation was present even after adjusting the percentages for case-mix and state-level policies, such as prescription drug monitoring programs.
In the year leading up to the total joint replacement, 1 in 6 participants used long-term prescription opioids. On average, the opioids were taken for 7 months.2
Among those who took the long-term opioid therapy, nearly 20% had an average daily dose of ≥50 morphine milligram equivalents.2
Participants’ access to a primary care provider was modestly associated with rates of long-term opioid use while their access to a rheumatologist was not associated with long-term opioid use.
—Colleen Murphy
References:
1. Desai RJ, Jin Y, Franklin PD, et al. Association of geography and access to healthcare providers with long term prescription opioid use in Medicare patients with severe osteoarthritis: a cohort study [published online January 28, 2019]. Arthritis Rheumatol. https://doi.org/10.1002/art.40834.
2. Study examines long-term opioid use in patients with severe osteoarthritis [press release]. Hoboken, NJ: Wiley; January 28, 2019. https://newsroom.wiley.com/press-release/arthritis-rheumatology/study-examines-long-term-opioid-use-patients-severe-osteoarthri. Accessed January 28, 2019.