MMWR: Increased Opioid Use in Lupus Save

Opioids are generally not indicated for pain in systemic lupus erythematosus (SLE) and other rheumatic diseases because of limited efficacy and risks for addiction and adverse health effects.

MMWR reports that nearly one third of patients with SLE in an established Michigan cohort used prescription opioids, with approximately two thirds of those using for >1 year. Emergency department use by SLE patients was associated with increased prescription opioid use.

SLE patients have their own morbities and comorbidities. While pain can be a symptom in lupus, the need for narcotics should be rare at best. Short or long-term opioid therapy in these patients should be concerning, if not alarming, and prompt strategies for reducing overall opioid use.

A study compared 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort with 192 frequency-matched persons without SLE.

They found that nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014–2015), compared with 8% of persons without SLE (p<0.001). Among the SLE patients using opioids, 97 (68%) were using them for >1 year, and 31 (22%) were concomitantly on two or more opioid medications.

Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3–3.6; p = 0.004).

The odds of opioid use among SLE patients were 3 times higher than for nonpatients (OR = 3.4, 95% CI = 1.7–6.6; p <0.001) after accounting for demographic, psychosocial, and clinical factors (Table 3). In analyses of both the total study population and SLE patients only, prescription opioid use was twice as likely among persons who had at least one ED visit in the last 12 months (total population: OR = 2.2, 95% CI 1.4–3.6), SLE patients only: OR = 2.1, 95% CI = 1.3–3.6).

Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.