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01-06-2020 | Opioids | Original Article

Mental health conditions and the risk of chronic opioid therapy among patients with rheumatoid arthritis: a retrospective veterans affairs cohort study

Authors: Justin S. Liberman, Lucy D’Agostino McGowan, Robert A. Greevy, James A. Morrow, Marie R. Griffin, Christianne L. Roumie, Carlos G. Grijalva

Published in: Clinical Rheumatology | Issue 6/2020

Abstract

Objective

Patients with rheumatoid arthritis (RA) often receive opioid analgesics for pain management. We examined the association between mental health conditions and the risk of chronic opioid therapy.

Methods

A retrospective cohort of veterans with RA initiating opioid use was assembled using Veterans Health Administration databases (2001–2012). Mental health conditions included anxiety (N = 1108, 12.9%), depression (N = 1912, 22.2%), bipolar disease (N = 131, 1.5%), and post-traumatic stress disorder (N = 768, 8.9%) and were identified by ICD coded diagnoses and use of specific medications. Cohort members were followed from opioid initiation through chronic opioid therapy, defined as the continuous availability of opioids for at least 90 days. Multivariable Cox proportional hazard regression models assessed the association between mental health conditions and chronic opioid therapy accounting for relevant covariates. Subgroup analyses examined whether the strength of the observed association varied by the duration of the initial opioid prescription.

Results

We identified 14,767 patients with RA with 22,452 episodes of opioid use initiation. Mental health conditions were identified in 8607 (38.3%) patients. Compared with patients without mental health conditions, patients with mental health conditions have a higher risk of developing chronic opioid therapy (469.3 vs 378.1 per 1000 person-years, adjusted hazard ratio [aHR] 1.18, 95% CI 1.09, 1.29). The increased risk was highest for those with a history of opioid use disorder (aHR 1.94, 95% CI 1.09, 3.46) and also elevated for those with other substance use disorders (aHR 1.35, 95% CI 1.05, 1.73). Duration of the initial opioid prescription was independently associated with chronic opioid therapy, regardless of the estimated opioid daily dose.

Conclusions

History of mental health conditions and duration of the initial opioid prescription were associated with an increased risk of chronic opioid therapy among patients with RA.

Key Points

• Approximately a third of patients with RA are exposed to opioid analgesics.

• Patients with RA and history of mental health disease, especially substance use disorders, who initiate opioid use have an increased risk of chronic opioid therapy.

• This study provides insight in an underrepresented population of mainly male patients with RA.

Available only for authorised users

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Title: Mental health conditions and the risk of chronic opioid therapy among patients with rheumatoid arthritis: a retrospective veterans affairs cohort study
Authors: Justin S. Liberman
Lucy D’Agostino McGowan
Robert A. Greevy
James A. Morrow
Marie R. Griffin
Christianne L. Roumie
Carlos G. Grijalva
Publication date: 01-06-2020
Publisher: Springer London
Keywords: Opioids
Opioids
Disease Modifying Anti-Rheumatic Drug
Analgesics in Dentistry
Rheumatoid Arthritis
Published in: Clinical Rheumatology / Issue 6/2020
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-020-04955-2

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Objective

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Results

Conclusions

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Objective

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Conclusions

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