Recent Opioid Prescription Trends and Patterns. Troubling? –

Armed with data from more than 41 million patients, researchers from Wake Forest Baptist Health, Cleveland Clinic Foundation, and Michigan State University took a deep dive into opioid prescription trends and patterns for knee osteoarthritis (OA).
Their work, “Addressing National Opioid Prescribing Practices for Knee Osteoarthritis: An Analysis of an Estimated 41,389,332 Patients With Knee Arthritis,” was published in the April 1, 2021 edition of the Journal of the American Academy of Orthopaedic Surgeons.
Co-author Chukwuweike Gwam, M.D. is with the Department of Orthopedic Surgery at the Wake Forest School of Medicine, and told OTW,Degenerative knee osteoarthritis is a common problem that can lead to chronic pain and disability. New research has revealed that long term opioid use prior to knee replacement surgery is associated with an increased rate of complications postoperatively.”
“Despite efforts to curb opioid use and misuse, the literature revealed a significant number of patients using opioid-based medications for chronic knee pain. The purpose of this study was to identify trends and factors associated with opioid prescriptions across medical specialties to find underlying reasons for continued opioid prescription patterns despite concerns with their use for arthritis pain.”
The researchers used data from the National Ambulatory Medical Care Survey, identifying all patients in the United States who presented to an outpatient clinic for knee OA between 2007 and 2016. Of the 41,389,332 patients, 12.8% were prescribed an opioid-based medication. The researchers found that opioid prescription rose from 2007/2008 to 2013/2014, with the prescription of hydrocodone-based medication and other traditional opioids following those trends. Tramadal prescriptions rose, peaking in 2015/2016. Patient income in the lowest quartile, a worker’s compensation status, and depression were independently associated with higher odds of opioid prescription for knee OA.
Solving one problem, creating another?
Dr. Gwam said to OTW, “We found that patients were being prescribed more than one opioid-based medication for knee osteoarthritis. While there was an overall decrease in opioid-based medication prescription rates for knee osteoarthritis, there was a steady increase in tramadol prescriptions for knee osteoarthritis. Interestingly, increasing patient income was associated with lower odds of being prescribed opioids for knee osteoarthritis.”
Our work highlights the need for interdisciplinary communication in treating patients with knee osteoarthritis prior to surgery. For patients with chronic knee pain from osteoarthritis, opioid pain medication is not a first line treatment and other options such as anti-inflammatory medications, activity modifications, braces, and physical therapy should be recommended.”
The next step in this analysis will be to follow trends in tramadol prescribing practices for knee arthritis and assess the role of state level regulations on tramadol prescribing practices. Tramadol is less potent opioid medication and has been previously recommend for chronic arthritis pain; however, based on the current opioid medication overuse in the population, this will need to be reevaluated.”
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