Despite Warnings, Opioid Prescriptions Still Widespread in Osteoarthritis

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Despite recommendations against using opioids and benzodiazepines to treat osteoarthritis pain, new research shows significant numbers of patients, especially older patients, are still receiving prescriptions for these medications.

According to a new study published in Arthritis Care & Research, not only are more than a quarter of osteoarthritis patients obtaining prescriptions, but many also have a risk factor for abusing the drugs.

“Despite practice guidelines suggesting otherwise, opioids are being used for management of osteoarthritic pain,” said study author Rachel Seymour, Ph.D., vice chair of research and professor at the Atrium Health Musculoskeletal Institute. “Significant amounts of these medications are being prescribed both to groups potentially at risk for misuse, as well as the elderly.”

In a descriptive analysis study, researchers identified 31,123 patients with osteoarthritis. Twenty-seven percent , or 8,420 patients, had active opioid or benzodiazepine prescriptions with hydrocodone-acetaminophen and oxycodone-acetaminophen being the most frequently prescribed. Of all prescriptions, 95.9 percent were opioids, 2.3 percent were benzodiazepines, and 1.8 percent were both. And, 36 percent of recipients had at least one risk factor for misuse, including early refills or a history of multiple prescriptions in the past 30 days.

Study results also revealed 31.9 percent of individuals over age 65 received opioid prescriptions, frequently to combat knee or hip osteoarthritis pain, despite being at a 3.7-times greater risk for overdose. If coupled with a benzodiazepine, the overdose risk rises to five-fold. These medications also put older adults at a greater risk for falls, hypertension, diabetes, and heart disease, researchers said.

Investigators also discovered advanced care practitioners were responsible for 54.1 percent of prescriptions. This was concerning, they said, because it’s harder for non-pain specialty clinics to manage these prescriptions as they don’t have the same resources that pain management practices have to reduce opioid usage.

Ultimately, researchers said, clinicians should consider alternative treatment modalities, such as NSAIDs, acetaminophen, cryotherapy, and cognitive behavior therapies in an effort to help patients manage their osteoarthritis symptoms. Additionally, setting up an alert system in the electronic medical record could also help limit opioid or benzodiazepine prescriptions written to patients with risk factors.

REFERENCE

Alamanda V, Wally M, Seymour R, Springer B, Hsu J, Opioid and benzodiazepine prescriptions for osteoarthritis remain prevalent, Arthritis Care & Research (2019), doi: 10.1002/acr.23933.