Factors associated with long-term opioid use among patients with AxSpA or PsA who initiated opioids

Objective
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.

Methods
Adult patients with AxSpA/PsA and without prior cancer who initiated opioids between 2006-2021 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.

Results
In total 10,300 opioid initiations were identified from 8,212 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).

Conclusions
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.