Prevalence of Opioid and Benzodiazepine Prescriptions for Osteoarthritis

Abstract

Objective. Opioids and benzodiazepines are commonly used for management of osteoarthritis, despite evidencebased recommendations to the contrary. This study aimed to quantify the prevalence of opioid and benzodiazepine prescribing for osteoarthritis. Additionally, we aimed to characterize risk factors for prescription drug misuse, abuse, and diversion among this population.Methods. We conducted a descriptive analysis of adult outpatient encounters with a primary diagnosis of osteoarthritis during a 1-year period at a large health care system, excluding cancer and outpatient procedures. Demographic data, prescription data, and patient-specific risk factors were collected. Descriptive analysis was conducted to characterize arthritis patients who received and did not receive prescription opioids.Results. During 1 year, our system had 31,123 outpatient encounters for osteoarthritis. Opioids and benzodiazepines were prescribed for nearly 27% of the encounters (n = 8,420). In all, 43% of the encounters involved patients age ≥65 years. Hydrocodone-acetaminophen was the most common medication prescribed (34.3%). Most prescriptions were written by pain specialists (53%). A total of 35.5% of patients had a risk factor for prescription misuse, the most prevalent being early refill and a history of receiving ≥3 prescriptions in the past month.Conclusion. Prescriptions for opioids and benzodiazepines continue to be written for osteoarthritis. These prescriptions may pose a risk for adverse outcomes since >1 in 5 patients receiving prescriptions had a risk factor for misuse. Continued efforts to improve compliance with evidence-based guidelines as well as multimodal and alternative pain management pathways are critical to help curb the use of opioids for management of osteoarthritisrelated pain. Level of evidence: level IV.

Pain Pharmacotherapy in a Large Cohort of Patients with Osteoarthritis: A Real-World Data Analysis

“…In contrast, a recent publication from Belgium [22] reported that NSAIDs were prescribed to 29.4% of knee OA patients in 2015, a relatively similar rate to our observation in Israel. We found that 22.9% of OA patients used opioids, similar to the rates observed in Sweden (23.7%) [23] and the US (27%) [31], but higher than the 10% reported in Belgium [22] and Japan [18]. Paracetamol was used by approximately 20% of the OA patients in our study, a similar rate to Japan [18] and Belgium [22], but much higher than in Korea [21].…”

Management of Osteoarthritis During the COVID‐19 Pandemic

“…Delayed virus clearance for SARS 74 and MERS 73 but reduced mortality with SARS. 77 No association with virus clearance and duration of symptoms in COVID-19 80 No evidence for discontinuation for systemic treatment -Balance cost/benefit for patients with weak symptoms Opioids Abuse and misuse, 93 constipation, nausea/ vomiting, 94 respiratory depression. 85 Increased risk for general AEs in OA patients.…”

“…91 Notably, considering the different administration routes, no differences in the overall adverse event profile emerged between transdermal opiates and oral treatments. 92 Nevertheless, the risk for adverse outcomes due to opioid abuse remains, since more than 20% of OA patients receiving prescriptions have a risk factor for misuse, 93 and associated adverse events (constipation, nausea/vomiting). 94 Being aware of the several molecules used in OA management, we will below report available information about two widely prescribed weak opioids, with and without immunosuppressive activity, due to their possible reduced interaction with respiratory tract infections and their preferential use in place of paracetamol or NSAIDs.…”

Pc-Facs

“…PRISM is a novel resilience intervention for AYAs with cancer that has shown higher patient-reported resilience, quality of life, hope, and benefit finding and lower distress, thus resulting in parents of AYAs wanting similar intervention for themselves. 3,4 Hence, PRISM-P was adapted. To minimize variance, the same psychologist delivered this phase 2 trial.…”

“…First, concurrent opioids/benzodiazepine-S use remains higher in the cancer population than other populations. 4,5 Next, it is possible to transition some patients receiving these combinations to other nonsedating agents without worsening their symptoms.…”