Opioid Use Among Medicare Beneficiaries With Knee Osteoarthritis: Prevalence and Correlates of Chronic Use

Abstract

Objective. To determine the prevalence of chronic and occasional opioid use and identify risk factors of opioid use among persons with knee osteoarthritis (OA).Methods. We used the Medicare Current Beneficiary Survey to select a knee OA cohort. We obtained data on demographics characteristics, marital status, comorbidities, insurance, and prescription medication coverage from survey data and linked Medicare claims. We included all prescribed medication records classified as opioid under the First Databank therapeutic antiarthritics or analgesics categories. We stratified individuals with knee OA into 3 opioid use groups: 1) nonusers (0 prescriptions/year), 2) occasional users (1-5 prescriptions/year), and 3) chronic users (6+ prescriptions/year). We built multivariable logistic regression models using a generalized estimating equation to determine correlates of chronic opioid use.Results. Among 3,549 Medicare beneficiaries with knee OA and a mean ± SD age of 78 ± 7 years, 68% were female, 9% were chronic users, and 21% used opioids occasionally. Multivariable analysis showed that non-Hispanic ethnicity (odds ratio [OR] 4.8, 95% confidence interval [95% CI] 2.2-10.2), divorced status (vs. married; OR 2.3, 95% CI 1.5-3.5), Medicaid eligibility (OR 1.9, 95% CI 1.3-2.7), depression (OR 1.9, 95% CI 1.5-2.5), chronic obstructive pulmonary disease (OR 1.9, 95% CI 1.4-2.5), and inability to walk without assistive devices (vs. no difficulty walking; OR 2.4, 95% CI 1.5-3.7) were independently associated with chronic opioid use.Conclusion. A total of 9% of persons with knee OA use opioids chronically. Efforts to find nonopioid regimens for treating knee OA pain should be tailored to patients at high risk for chronic use.

Societal Cost of Opioid Use in Symptomatic Knee Osteoarthritis Patients in the United States

“…Opioid prescriptions for musculoskeletal pain have substantially contributed to opioid misuse in the US (46). Encouragingly, the prevalence of opioid use among those with knee OA has decreased each year from 2013 to 2016 (23), resulting in an estimated $20 billion decrease in lifetime knee opioid‐related costs. These data document the substantial impact that can be achieved by providing alternatives to opiates for knee OA pain management.…”

“…A recent analysis of data from the Medicare Current Beneficiary Survey (MCBS) found that prolonged opioid use among knee OA patients decreased from 12% in 2013 to 4% in 2016 (23). Despite these encouraging changes in opioid prescription practices, even a small proportion of SKOA patients in the US using opioids on a prolonged basis likely results in a large societal cost.…”

Knee Osteoarthritis, Falls, and Opioids: Interactions and Recommendations

“…In the interim, since multiple findings point to a consistent negative influence of opioid usage on falls frequency in older adults [46,47] Yoshikawa., et al [48] imply caution is advised regarding the extended usage of opioids for purposes of alleviating knee osteoarthritis pain among older adults at high risk for falls [47,48]. This is indicated both before as well after any knee joint replacement surgery [49].…”

Impact of Lifestyle on Knee Osteoarthritis in Mosul Hospitals

“…Other studies results show similar findings in China, USA, and from six continents in over world. (13)(14)(15) In table 2 The findings show the majority of knee osteoarthritis patients do not routinely follow healthy lifestyle habits. For example, just 27.04% of patients said they regularly took responsibility for their health, and only 7.13% of patients said they regularly exercised.…”