Prescription opioids are generally used long-term for treating chronic pain in older patients suffering from severe osteoarthritis.
In a new study, appeared in Arthritis & Rheumatology (an official journal of the American College of Rheumatology), a team of researchers from Harvard Medical School has found significant statewide differences in treatment rates of long-term opioid therapy for osteoarthritis. In addition, it was not completely explained by variation in characteristics of the patients or access to healthcare providers.
Using prescription opioids for long term to treat chronic pain simultaneously carries the dependence risks and other serious harms. In the United States, osteoarthritis in the knee or hip is considered to be a common source of chronic pain which affects around 30 million adults in the country and has a high prevalence, expected to increase with growing number of aging population.
In order to evaluate the long-term opioid use in patients with serious osteoarthritis and variation based on healthcare access and geography, the researchers analyzed 2010-2014 data obtained from Medicare on patients with osteoarthritis who are undergoing total joint replacement.
The study involved 358,121 patients with an average age of 74 years. About 16% of the patients took long-term prescription opioids for about 90 days in a year to manage the pain followed by total joint replacement, with an average period of nearly 7 months.
Most strikingly, the researchers found that around 20% of long-term opioid users were taking a daily dose of these drugs equivalent to 50mg of Morphine, an amount identified by new guidelines as potentially imparting a higher risks of opioid-associated harms.
The average percentage of long-term opioid users among patients with severe osteoarthritis varied broadly across states in a range of 26.4 percent in Alabama to 8.9 percent in Minnesota. Lead researcher Rishi J. Desai, MS, PhD and his colleagues also found that access to primary care providers was only modestly linked to rates of long-term opioid use, while access to rheumatologists was not linked to long-term opioid use.
The study results suggest that prescribing practices across different regions are key determinants of using prescription opioids in chronic pain or osteoarthritis patients. According to Dr. Desai, geographically targeted dissemination strategies for safe opioid prescribing guidelines may be needed to address the high use observed in certain states.