Trends for opioid prescribing and the impact of the COVID-19 pandemic in patients with rheumatic and musculoskeletal diseases between 2006-2021.

Publication date: Jul 11, 2023

To investigate opioid prescribing trends and assess the impact of the pandemic on opioid prescribing in RMDs. Adult patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (AxSpA), systemic lupus erythematosus (SLE), osteoarthritis (OA) and fibromyalgia with opioid prescriptions between 01/Jan/2006─31/Aug/2021 without cancer in UK primary care were included. Age- and gender-standardised yearly rates of new and prevalent opioid users were calculated between 2006─2021. For prevalent users, monthly measures of mean morphine milligram equivalents (MME)/day were calculated between 2006─2021. To assess the impact of the pandemic, we fitted regression models to the monthly number of prevalent opioid users between Jan/2015─Aug/2021. The time coefficient reflects the trend pre-pandemic and the interaction term coefficient represents the change in the trend during the pandemic. The study included 1,313 519 RMD patients. New opioid users for RA, PsA and fibromyalgia increased from 2. 6, 1. 0, and 3. 4/10 000 persons in 2006-4. 5, 1. 8, and 8. 7 in 2018 or 2019. This was followed by a fall to: 2. 4, 1. 2, and 5. 9 in 2021 respectively. Prevalent opioid users for all RMDs increased from 2006 but plateaued/dropped beyond 2018, with a 4. 5-fold increase in fibromyalgia between 2006─2021. In this period, MME/day increased for all RMDs, with the highest for fibromyalgia (≥35). During COVID-19 lockdowns, RA, PsA and fibromyalgia showed significant changes in the trend of prevalent opioid users. The trend for fibromyalgia increased pre-pandemic and started decreasing during the pandemic. The plateauing/decreasing trend of opioid users for RMDs after 2018 may reflect the efforts to tackle the rising opioid prescribing in the UK. The pandemic led to fewer people on opioids for most RMDs, reassuring there was no sudden increase in opioid prescribing during the pandemic.

Concepts Keywords
Models axial spondyloarthritis
Monthly COVID-19
Rheumatoid fibromyalgia
psoriatic arthritis
rheumatoid arthritis
systemic lupus erythematosus


Type Source Name
disease MESH COVID-19 pandemic
disease MESH musculoskeletal diseases
disease MESH rheumatoid arthritis
pathway KEGG Rheumatoid arthritis
disease MESH psoriatic arthritis
disease MESH axial spondyloarthritis
disease MESH systemic lupus erythematosus
pathway KEGG Systemic lupus erythematosus
disease MESH osteoarthritis
disease MESH fibromyalgia
disease MESH cancer
disease VO age
disease VO monthly
drug DRUGBANK Morphine
disease VO time

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