An observational cohort study published in Arthritis & Rheumatology evaluated how geography and healthcare access affect long-term opioid use in patients with severe osteoarthritis (OA). The researchers found that statewide treatment strategies vary significantly by state, but differences in access to healthcare providers, varying case‐mix, and state‐level policies did not comprehensively explain the differences.
The study included OA patients in the Medicare program (2010–2014) who required total joint replacement (TJR). They compared patients based on state of residence and healthcare access; they also considered state-level differences in drug monitoring programs and whether medical marijuana was legal.
Long-term #opioid use prior to total joint replacement was highly prevalent in elderly patients with #osteoarthritis. And it varies substantially by state: https://t.co/mdq4O9EgYU pic.twitter.com/7YQ2pg5tXm
— MDEdge (@MDEdgeTweets) January 29, 2019
In total, data from 358,121 severe OA patients (mean age, 74 years) were included in the analysis, spanning 4,080 primary care service areas. Overall, one in six patients were considered long-term prescription opioid users, using the drug for pain management longer than 90 days in the year preceding TJR for about seven months. Almost a fifth of long-term users were taking a daily dose associated with potential adverse effects.
Pleased to share our latest paper documenting long-term prescription opioid use in older folks with severe knee or hip osteoarthritis who eventually received total joint replacementhttps://t.co/3xlreZzVoZ
Some thoughts in this thread.. pic.twitter.com/I2QRjr76xi
— Rishi J Desai (@Rishidesai11) January 29, 2019
In both adjusted and unadjusted models, the mean percentage of long-term opioid users changed significantly across the nation, from 8.9% in Minnesota to 26.4% in Alabama. Access to primary care providers had only somewhat of an impact on long-term opioid use rates, and rheumatologist access did not impact long-term opioid use.
“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 study author Rishi J. Desai, MS, PhD, of Brigham and Women’s Hospital and Harvard Medical School, in a press release.
Source: Arthritis & Rheumatology