Opioid use is highest in the most disadvantaged arthritis patients

People with inflammatory arthritis taking high potency opioids are typically older and have a lower socioeconomic status than people taking no opioids or low potency opioids.

But it is their higher disability (HAQ) scores that is the most significant predictor of high potency opioid use, according to research from the Australian Rheumatology Association Database (ARAD).

The study, presented in a poster at APLAR-ARA, found 30.8% of 5,634 ARDA participants were taking some form of opioids.

Almost a quarter (24.2%) of all the patients were taking low potency opioids such as tramadol or codeine in combinations with aspirin or paracetamol; 6.6% of patients used high potency opioids such as morphine, oxycodone or fentanyl.

The study, led by ARAD project officer Ashley Fletcher and Professor Catherine Hill of the Royal Adelaide Hospital, found people in the lowest socioeconomic group take significantly more high potency opioids than people in the highest SES group (10.6% v 5.3%)

SES was based on the Socioeconomic Indexes for Areas (SEIFA) determined by their addresses.

Patients taking high potency opioids had a mean HAQ score of 1.6 compared to 1.2 in the group taking low potency opioids and 1.0 for people not taking opioids.

High potency opioid users were also more likely to be permanently unable to work (32.4%) compared to low potency opioid users (12.4%) and non-opioid users (8.5%).

“When significant factors were considered in a multivariable model (including HAQ score (OR 6.4; 95% CI 5.5-7.4) and being permanently unable to work (OR 4.2; 95% CI 3.1-5.8)), potent opioid use was still significantly more prevalent in lower SES,” the researchers said.

The study also found 69.3% of high potency opioid users and 66.6% of low potency opioid users tended to stay on the drugs ‘despite guidelines recommending cessation of use if pain is not controlled by opioids’.

The researchers said further research was required into predictors of cessation and prescriber characteristics.

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