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Opioid-Use Disorder Hospitalizations Increasing in Patients with Rheumatic Diseases

Atlanta, GA—Results of a clinical trial presented at the 2019 American College of Rheumatology Annual Meeting revealed a dramatic increase in opioid-use disorder (OUD) hospitalizations over the past 20 years in patients with rheumatic diseases, including gout, osteoarthritis, fibromyalgia, low back pain, and rheumatoid arthritis.

“Chronic musculoskeletal diseases are common causes of chronic pain, and patients with these diseases are at risk of receiving opioids and potentially developing an OUD,” said the lead investigator, Jasvinder Singh, MD, MPH, Professor, Rheumatology and Clinical Immunology, School of Medicine, The University of Alabama at Birmingham. “We were interested in understanding the magnitude of the OUD problem, especially with regard to the impact on hospitalization rates and time-trends. We wanted to assess whether the problem was stable or increasing over time. A knowledge of OUD-related hospitalizations provides a good assessment of impact on patient morbidity and also utilization of health services that are expensive.”

Study Details

The investigators used the US National Inpatient Sample (NIS) data from 1998 to 2014 to examine rates of OUD hospitalizations without overdose or rehabilitation services, based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes for opioid dependence or abuse in the primary diagnostic condition. The 5 conditions chosen for evaluation were gout, osteoarthritis, fibromyalgia, low back pain, and rheumatoid arthritis. The incidence of OUD claims was assessed per 100,000 NIS claims overall.

In 1998-2000, the incidence of OUD-related primary hospitalizations was low for the 5 musculoskeletal conditions and increased exponentially over the next 14 years, based on 2-year assessments.

In patients with gout, the hospitalization rate per 100,000 in 1998 to 2000 was 0.05. In 2015 to 2016, that rate had jumped to 1.88—a 35-fold increase in 19 years. This was the largest percentage increase of all musculoskeletal conditions included in the trial.

In patients with OA, the rate of OUD-related hospitalizations was 0.68 per 100,000 in 1998 to 2000; however, that number rose to 10.22 per 100,000 in 2015 to 2016, which represents a 14-fold increase.

Patients with fibromyalgia experienced OUD-related hospitalizations at a rate of 0.53 per 100,000 in 1998 to 2000; by 2016, that number had increased 12-fold to 6.98 per 100,000. The investigators noted that there was a plateau effect that occurred in regard to hospitalizations in these patients, with the rate per 100,000 peaking in the 2013-2014 time frame at 7.22 and decreasing to 6.98 in the 2015 to 2016 period.

Another rheumatic condition that appeared to experience a plateau effect regarding the incidence of OUD-related hospitalizations was lower back pain. With a rate of 1.17 per 100,000 in the 1998-2000 time frame, investigators found that rates increased until the 2011- 2012 period when rates peaked at 8.25 per 100,000. Subsequently, those rates dropped to 7.43 per 100,00 from 2013 to 2014 and then increased again to 7.64 from 2015 to 2016.

In patients with rheumatoid arthritis, the rate per 100,000 in 1998 to 2000 was 0.30 and that number increased to 3.16 by the 2015-2016 time frame. These statistics represent a 9-fold increase in hospitalization rates for these patients.

Call to Action

According to Dr Singh, these findings should serve as a warning to alert patients, providers, and policymakers to address the risk for OUD in individuals with these 5 conditions associated with chronic pain.

“The findings should alert patients and providers and encourage them to have an open dialogue regarding risks versus benefits at the time of initiating or deciding to continue opioids. The dramatic increase in OUD hospitalizations over time for these five common rheumatic conditions should highlight the need for policy initiatives. Policy makers and federal research funders should prioritize interventions to reduce the risk of OUD and related hospitalizations – these diseases are targets for urgent attention,” Dr Singh stated.

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