Background/Purpose: SLE is a complex illness that can be associated with chronic pain. In recent years, an international opioid epidemic has become a major public health concern and is attributed, in part, to prescription opioids. We assessed contemporary patterns of opioid prescribing among patients with SLE in a general population context and examined potential associations with prescription opioid use.

Methods: Using a United Kingdom general population database, we conducted a cohort study of adult SLE patients, identified by Read codes. The exposures of interest were opioid prescriptions between January 1, 2007 and December 31, 2016. We classified opioids as weak, including tramadol and codeine, and strong, including hydrocodone, morphine, fentanyl, oxycodone, hydromorphone, and methadone. We examined the proportion of patients receiving prescriptions for weak and strong opioids and performed logistic regression to assess whether prescription use of these medications varied by age, sex, duration of SLE, other medication use for SLE, comorbid conditions, lifestyle exposures, and socioeconomic status. We adjusted for age and sex.

Results: Of 10,784 SLE patients, (86% female, mean age 51.2 years), 32% were prescribed weak opioids and 10% were prescribed strong opioids during the study period. 21% and 7% received multiple prescriptions for weak and strong opioids, respectively. Concomitant diagnoses of fibromyalgia and OA each increased the odds of receiving prescription opioids (adjusted odds ratios [aOR] for strong opioids: 2.37 [96% CI 1.84-3.06] and 1.22 [95% CI 1.03-1.44] for fibromyalgia and OA, respectively) ( Table 1). SLE patients who were also taking NSAIDs, DMARDs, or glucocorticoids each had increased odds of receiving prescription opioids. Current smokers were also more likely to be prescribed prescription opioids. There was a trend towards higher odds of prescription opioid use with increasing deprivation score, a measure of socioeconomic status; the aOR was 1.33 (95% CI 1.03-1.71) for weak opioid use among the highest deprivation quintile.

Conclusion: In this general population-based cohort study, nearly one-third of SLE patients were prescribed weak opioids and 10% were prescribed strong opioids. Prescription opioid use is higher among patients who are also taking NSAIDs, glucocorticoids, and DMARDs, among those with lower socioeconomic status, and in those with concomitant fibromyalgia or OA. These findings indicate the use of these potentially dangerous medications among a substantial portion of SLE patients. Future studies should assess the impact of opioid usage on mortality and other important outcomes among patients with SLE.

Final Table 1 ACR abstract opioids in SLE

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/contemporary-prescription-opioid-use-and-predictors-among-patients-with-systemic-lupus-erythematosus/