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

Publication date: Feb 08, 2020

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.

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.

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.

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.

Liberman, J.S., D’Agostino McGowan, L., Greevy, R.A., Morrow, J.A., Griffin, Roumie, C.L., and Grijalva, C.G. Mental health conditions and the risk of chronic opioid therapy among patients with rheumatoid arthritis: a retrospective veterans affairs cohort study. 04627. 2020 Clin Rheumatol.

Concepts Keywords
Accounting Elevated substance disorders
Analgesics Pain
Anxiety Pain management
Bipolar RTT
Cohort Psychoactive drugs
Cohort Study Opioids
Covariates Morphinans
Depression Euphoriants
Opioid Morphine
Opioids Analgesic
Pain Management Pain management
Regression Rheumatoid arthritis
Rheumatoid Arthritis Heroin
Veterans Administration Opioid use disorder

Semantics

Type Source Name
disease MESH rheumatoid arthritis
pathway KEGG Rheumatoid arthritis
disease MESH anxiety
disease MESH depression
disease MESH post-traumatic stress disorder
disease MESH diagnoses
disease MESH substance use disorders

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