medwireNews: More than half of people with knee or hip osteoarthritis (OA) who receive opioids during their first year after diagnosis should not have been prescribed them, with inappropriate long-term use also common, study findings indicate.
“It can be speculated that strong pain medications such as opioids may appear as an ‘easy and quick fix’ for patients and/or clinicians, and may in turn present a barrier for utilization of more safe and effective initial treatment options,” Jonas Thorland (Lund University, Sweden) and co-authors write in Osteoarthritis and Cartilage.
The team analyzed population-based data from a single region in southern Sweden to ascertain the level of inappropriate opioid dispensing in patients with knee or hip OA. They defined inappropriate as the dispensing of opioids within the first year of diagnosis or long-term opioid use (>90 days’ supply within a 6-month period).
For the first part of their analysis, Thorland and co-investigators identified two cohorts of people with no history of OA between January 1998 and October 2012, who they retrospectively followed up for the development of knee (n=399,670) and hip (n=413,216) OA between November 2012 and October 2014.
During this follow-up period, 5866 (1.5%) patients in the knee cohort and 2359 (0.6%) in the hip cohort developed knee and hip OA, respectively. Of these, 14.7% and 20.7%, respectively, were dispensed opioids during the first year after diagnosis, most commonly codeine, oxycodone, and tramadol.
By comparison, the opioid dispensation rates were 4.9% and 5.1% among the people who did not develop knee or hip OA in their respective cohorts.
After adjustment for a number of confounders and comorbidities associated with opioid use, the researchers calculated that the rates of inappropriate opioid dispensing attributable to OA were 7.4% and 12.8%, in the knee and hip cohorts, respectively.
“This implies that at least 50% of all incident opioid dispensations within the first year of knee OA diagnosis, and 62% of those for hip OA diagnosis, were inappropriate,” Thorland et al remark, describing this finding as “particularly concerning.”
In the second part of their analysis, the investigators found that among 48,574 people with physician-diagnosed knee OA, hip OA, or both, the prevalence rates of long-term opioid dispensing were 3.9%, 4.4%, and 6.3%, respectively. By contrast, the rate was 1.6% among 457,587 people without knee or hip OA.
The corresponding proportions of OA patients with inappropriate long-term opioid dispensing were 1.3%, 2.0%, and 2.4%, indicating that 33%, 45%, and 38% of long-term opioid use, respectively, was “attributable to OA and considered inappropriate,” report the authors.
They say that based on data from the Global Burden of Disease Study 2016, in which the annual global incidence of knee and hip OA was approximately 15 million cases, an estimated 1.3 million people may be inappropriately dispensed opioids during their first year with the disease. Similarly, around 3.6 million of the 300 million people already affected by knee and hip OA may be considered as using long-term opioids inappropriately.
“These numbers indicate both the scale at which patients with new OA diagnoses may be receiving opioids instead of safe, effective, guideline recommended first-line treatments, as well as the high proportion of inappropriate, long-term opioid use among existing OA patients,” Thorland and colleagues conclude.
By Laura Cowen
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Osteoarthritis Cartilage 2019; doi:10.1016/j.joca.2019.10.004