Factors associated with long-term opioid use among patients with axial spondyloarthritis or psoriatic arthritis who initiate opioids.

Abstract

Up to one in five patients with axial spondyloarthritis (AxSpA) or psoriatic arthritis (PsA) newly initiated on opioids transition to long-term use within the first year. This study aimed to investigate individual factors associated with long-term opioid use among opioid new users with AxSpA/PsA. Adult patients with AxSpA/PsA and without prior cancer who initiated opioids between 2006 and 2021 were included from Clinical Practice Research Datalink Gold, a national UK primary care database. Long-term opioid use was defined as having ≥3 opioid prescriptions issued within 90 days, or ≥90 days of opioid supply, in the first year of follow-up. Individual factors assessed included sociodemographic, lifestyle factors, medication use and comorbidities. A mixed-effects logistic regression model with patient-level random intercept was used to examine the association of individual characteristics with the odds of long-term opioid use. In total, 10 300 opioid initiations were identified from 8212 patients (3037 AxSpA; 5175 PsA). The following factors were associated with long-term opioid use: being a current smoker (OR: 1.62; 95%CI: 1.38,1.90), substance use disorder (OR: 2.34, 95%CI: 1.05,5.21), history of suicide/self-harm (OR: 1.84; 95%CI: 1.13,2.99), co-existing fibromyalgia (OR: 1.62; 95%CI: 1.11,2.37), higher Charlson Comorbidity Index (OR: 3.61; 95%CI: 1.69,7.71 for high scores), high MME/day at initiation (OR: 1.03; 95%CI: 1.02,1.03) and gabapentinoid (OR: 2.35; 95%CI: 1.75,3.16) and antidepressant use (OR: 1.69; 95%CI: 1.45,1.98). In AxSpA/PsA patients requiring pain relief, awareness of lifestyle, sociodemographic and prescribing characteristics associated with higher risk of long-term opioid use can prompt timely interventions such as structured medication reviews and smoking cessation to promote safer prescribing and better patient outcomes.