The complexity of opioid use in spondyloarthritis Save

A few things we know about opioids: use is common; it’s not efficacious in the treatment of spondyloarthritis; and, there is an opioid epidemic and its users are stigmatized. 

Opioid use can weigh heavily on the healthcare system as well as the patient’s overall wellbeing. Abstract 0402 looked at this topic in detail. This retrospective study looked at patients with psoriatic arthritis or ankylosing spondylitis in the FORWARD databank. 

They found 21% of psoriatic arthritis patients and 27% of ankylosing spondylitis patients used opioids. These users tended to have more co-morbidities, higher prevalence of smoking, worse disease activity, and higher use of anti-rheumatic drugs. Additionally, these patients had more medical visits, an increased number of diagnostic tests, spent more annually on medical visits and spent more on drug costs. 

I won’t get into the topic of the opioid epidemic here, but this study reinforces what we already know about opioids and spondyloarthritis, which is that these patients tend to be sicker with more symptoms. However, I think seeing each category broken down really shows how using opioids as a “crutch” is the opposite of short term pain for long term gain. Unfortunately, I’ve seen patients who were prescribed opioids almost as a compromise between them and their other providers. Now, we’re seeing that a simple monthly refill can actually place a heavy burden on the healthcare system and the patient. 

Most importantly however, this study sheds new light and leaves us with some food for thought. 

First, why is it that opioid users have more comorbidities, higher prevalence of smoking, and worse disease activity? Are their conditions fully treated? Have we as rheumatologists investigated all possible DMARDs for that patient’s treatment? Should we be working closer with the patient and their primary care provider to optimize their other comorbidities? 

Smoking is tough and I never expect patients to fully quit after one visit. Often, I’ve heard providers tell patients “smoking is bad and you should stop.” I think by now, we all know that and smokers know that too. Have we asked ourselves why a patient smokes? Is it because they’re in so much pain that they just need another outlet? What can we do to help them quit smoking instead of a 10 minute lecture in the office?

The most striking piece of data from this study is that opioid users spent more on medical visits and more on drug costs. To me, that’s the biggest problem.

Do opioid users have lower access to health care and insurance coverage? Or do they even have insurance coverage at all? If they’re having to pay hundreds or thousands of dollars for a drug that someone else would pay $5 for, I can see how opting for opioids for a quick fix may be a logical option. Perhaps, we as a society need to help provide better access to healthcare and drugs instead of providing a quick fix that we know does not work. Perhaps, instead of stigmatizing the next opioid user and lecturing them on stopping opioids, we should ask them why they are using it.