Background/Purpose: The use or misuse of opioids has become a major public health issue in the USA. It is estimated that the economic burden of misuse of prescription opioids is approximately $78 billion/year,¹ and by 2009, opioid deaths outnumbered deaths from motor vehicle accidents.² In the 2000s, new standards from The Joint Commission led to increased prescribing of opioids for non-cancer pain.³

Ankylosing spondylitis (AS) is a serious, chronic inflammatory condition primarily involving the axial skeleton; progressive spinal pain is a hallmark of the disease. Recent treatment guidelines recommend use of non-steroidal anti-inflammatory drugs (NSAIDs) as initial pharmacotherapy, and TNF inhibitors (TNFi) in patients with insufficient response to NSAIDs; anti-IL17 therapies are not mentioned due to paucity of data and timing, and the use of opioids is not addressed.⁴ We performed an initial analysis to attempt to assess the use of opioids in patients with AS.

Methods: Patients aged ≥18 years with AS (ICD9 720.0, ICD10 M45.X) were identified in the Truven MarketScan^® database during the period 2011 to 2016. The period following the first AS medical code (i.e. index date) was then examined for claims for opioid medication dispensing. The concomitant use of TNFi and/or NSAIDs during the same follow-up period was also ascertained. Anti-IL17 therapies were not included in this analysis due to insufficient exposure data.

Results: Of the 56,236 patients with AS in the database, 27,347 (48.6%) had ≥1 opioid claim during the follow-up period. Among this subset of opioid-exposed AS patients, 9,808 (35.9%) also had a claim for a TNFi, 17,539 (64.1%) had a claim for an NSAID, and 20,449 (74.8%) received an NSAID and/or a TNFi during the follow-up period. The exposure rates were similar when the analysis was restricted to AS patients with ≥2 opioid claims during the follow-up period.

Conclusion: Opioid use is common among patients with AS. Of the AS patients using opioids in this analysis, approximately one-quarter were using only opioids and no medications recommended in treatment guidelines.⁴ In addition to the well-recognized public health and societal issues around opioid treatment, lack of therapies directed at inflammation almost certainly results in suboptimal treatment of this serious inflammatory condition. Further analyses are warranted to better assess the reasons for the lack of appropriate therapies and to understand which practitioners are prescribing the opioids; this methodology is unable to identify alternating use of medication types. Given the high usage of opioids in AS, appropriate circumstances for their use should be defined, and educational efforts should be made to help guide practitioners and patients to more appropriate therapies.

References:

1. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis [Accessed June 2017]

2. https://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf [Accessed June 2017]

3. Baker D. The Joint Commission’s Pain Standards: Origins and Evolution. Oakbrook Terrace, IL: The Joint Commission; 2017

4. Ward M. Arthritis Rheumatol 2016;68(2):282–98

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/opioid-use-in-patients-with-ankylosing-spondylitis/