ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 3086

Changing Patterns over Time in Opiate Use in U.S. Rheumatoid Arthritis Patients

Jeffrey Curtis1, Fenglong Xie2, Kenneth Saag3, Lang Chen2, Timothy Beukelman4, Melissa Mannion5 and Huifeng Yun6, 1Division Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 2Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 3University of Alabama at Birmingham, Birmingham, AL, 4Pediatric Rheumatology, University of Alabama-Birmingham, Birmingham, AL, 5Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 6Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Opioids and rheumatoid arthritis (RA)

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Clinical Aspects V: Challenges in the Assessment and Management of Established RA

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Opiate use has come under increasing scrutiny related both to over-use and under-use. The patterns of opiate use over time in a population-based cohort of patients with inflammatory diseases such as rheumatoid arthritis (RA) have not been well characterized. We used health plan data to characterize both trends over time as well as variability in individual physician prescribing of short and long term opiates.

Methods: We used national Medicare data from 2006-2014 and identified a closed cohort of RA patients by requiring two diagnosis codes (ICD9 714.0, 714.2, 714.81) from rheumatologists separated by 7 days. To be included in the analysis, patients must have at least 6 consecutive observable months (enrolled in Medicare Part A, Part B and Part D coverage, not enrolled in Part C) prior to 1/1/2007. Follow up started at 1/1/2007 and end at the earliest of: dis-enrollment, 90 days before death, or end of study (12/31/2014).  Any oral opiates use (one or more filled prescriptions) was assessed every six months for patients who remained under follow-up over the entirety of each 6 month interval. Generalized estimating equations with repeated measure was used to calculate odds ratios for the receipt of opiates in each 6 month interval.  A separate cohort was created using 2014 Medicare data to assess the variability in prescribing opiates among rheumatologists for their RA patients (assigned based on at least one physician encounter in 2014 with an RA diagnosis code). We restricted this analysis to rheumatologists with at least 10 RA patients enrolled in Medicare for the entire year. The proportion of RA patients using opiates was calculated by dividing RA patients with at least two opiate prescriptions in 2014 by the total number of RA patients treated by each U.S. rheumatologist.

Results: For the longitudinal analysis, we identified 73,834 RA patients meeting eligibility criteria. Patient characteristics were (mean age 67.6 (12.2), 80.0% Female, 80.1% White, 12.3% Black). In 2006, the most commonly used opiates were medications that combined acetaminophen with hydrocodone or with propoxyphene (withdrawn from U.S. in 2010). Over 2006-2014, trends (Figure) showed overall opiate use increased slowly but significantly and reach a peak in 2010, and decreased thereafter. Following the withdrawal of propoxyphene in 2010, use of hydrocodone and tramadol increased commensurately such that overall opiate use declined only slightly. Factors associated with opiate use included younger age, female, white race, disability, lower income and baseline NSAID use. In 2014, practice-level variability between U.S. rheumatologists (n=4,900) in the use of opiates for their RA patients was high. In rheumatology practices at the 50th percentile, 46% of RA patients used opiates. The proportion of patients using opiates at the 25th and 75th percentiles was 37% and 55%, respectively. At the extremes (1st and 99th percentile), 0-92% of RA patients within each rheumatologist’s practice were treated with opiates.  However, among all patients in the analysis, only 43% of RA patients had any of their opiate prescriptions written by a rheumatologist.

Conclusion: In the US, opiate use peaked in RA patients in 2010 and is now undergoing slight declines. There was substantial variability between rheumatologists in the proportion of their RA patients using opiates, although fewer than half of patients had their opiate prescriptions written by rheumatologists. Withdrawal of the 2nd most commonly used opiate (propoxyphene) from the U.S. market in 2010 had minimal effect on overall use, as it was replaced with greater use of other opiates.


Disclosure: J. Curtis, Roche/Genentech, UCB, Janssen, Corrona, Amgen, Pfizer, BMS, Crescendo, AbbVie, 2,Roche/Genentech, UCB, Janssen, Corrona, Amgen, Pfizer, BMS, Crescendo, AbbVie, 5; F. Xie, None; K. Saag, None; L. Chen, None; T. Beukelman, Novartis Pharmaceutical Corporation, 5,UCB, 5; M. Mannion, None; H. Yun, Amgen, 2.

To cite this abstract in AMA style:

Curtis J, Xie F, Saag K, Chen L, Beukelman T, Mannion M, Yun H. Changing Patterns over Time in Opiate Use in U.S. Rheumatoid Arthritis Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/changing-patterns-over-time-in-opiate-use-in-u-s-rheumatoid-arthritis-patients/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/changing-patterns-over-time-in-opiate-use-in-u-s-rheumatoid-arthritis-patients/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology