Physician Prescribing Patterns and Risk for Future Chronic Opioid Use among Patients with Rheumatoid Arthritis: A Prospective Observational Cohort Study

OBJECTIVE: To identify the extent to which opioid prescribing rates for patients with rheumatoid arthritis (RA) varied in the U.S. and to determine the implications of baseline opioid prescribing rates on future probability of chronic opioid use. METHODS: We identified patients with RA from physicians who contributed >/=10 patients within the first 12 months of participation in the Consortium of Rheumatology Researchers of North America (Corrona) RA registry. Baseline opioid prescribing rate was calculated by dividing the number of patients with RA reporting opioid use during the first 12 months by the number of patients with RA providing data that year. To estimate odds ratios (ORs) for chronic opioid use, we used generalized linear mixed models. RESULTS: The percent of patients who reported chronic opioid use during the follow-up period was 7.0% (163/2322) in the very low (referent) intensity prescribing group compared to 6.8% (153/2254) in the low intensity prescribing group, 12.5% (294/2352) in the moderate prescribing group, and 12.7% (307/2409) in the high prescribing group. The OR (95% confidence interval) for chronic opioid use after the baseline period was 1.16 (0.79 to 1.70) for patients of low prescribing physicians, 1.89 (1.27 to 2.82) for patients of moderate prescribing physicians, and 2.01 (1.43 to 2.83) for patients of high prescribing physicians, compared to very low prescribing physicians. CONCLUSIONS: Rates of opioid prescriptions varied widely. Baseline opioid prescribing rates were a strong predictor of whether a patient would become a chronic opioid user in the future, after controlling for patient characteristics.