The inconsistencies in long-term opioid use for severe osteoarthritis

An image showing an older person with hand pain
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New research published in Arthritis & Rheumatology, reveals inconsistencies in the long-term use of prescription opioids to treat pain in older patients with severe osteoarthritis.

The new research is titled “Association of geography and access to healthcare providers with long term prescription opioid use in Medicare patients with severe osteoarthritis: A cohort study.” The paper shows that there are substantial variations across US states in rates of treatment with long-term opioid therapy for patients with severe osteoarthritis. These variations could not be fully explained by differences in patient characteristics, or a difference in access to healthcare providers.

Osteoarthritis, specifically in the hip or knee, is a common source of chronic pain in the US, affecting almost 30 million US adults. Its prevalence is expected to increase due to the aging population.

What are the risks of long-term opioid use?

Using prescription opioids long-term to treat chronic pain has the risk of opioid dependence, among other serious harms.

What do the findings suggest?

An analysis 358,121 patients, aged 74 years old on average, showed that one in six patients used long-term prescription opioids, with an average duration of around seven months. Almost 20 percent of long-term users consumed an average daily dose which has been identified as potentially imparting a high risk of opioid-related harms.

The average percentage of severe osteoarthritis patients who use opioids long-term ranged from 8.9 percent in Minnesota, to 26.4 percent in Alabama. The access to primary healthcare providers was only modestly associated with these rates. Access to rheumatologists with not associated with long-term opioid use for patients with osteoarthritis.

Dr Rishi J. Desai, MS, PhD, of Brigham and Women’s Hospital and Harvard Medical School, commented:  “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.”

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