Chronic Opioids in Gout: A Matched Cohort Study from the Veteran's Health Administration.

Abstract

Objective: Though used frequently to treat flare, risk of chronic opioid exposure in gout has not been well defined. In this study, we examined the hypothesis that people with gout are more likely than individuals without gout to be prescribed chronic opioids over time.

Methods: In this matched cohort study using national Veterans Health Administration (VA) data, multivariable Cox regression was used to examine the association of gout with chronic opioid receipt (defined using a validated administrative algorithm). Gout cases were identified using diagnostic codes and matched with up to 10 non-gout controls by age, sex, and VA enrollment year. In analyses limited to gout, factors associated with chronic opioid exposure were identified.

Results: Over a mean follow-up of 4.52 years, gout patients were more likely to receive chronic opioids than controls (6.9% vs. 3.8%). This risk remained following covariate adjustment (aHR 1.30; 95% CI 1.28, 1.32). Among gout patients, factors independently associated with an increased likelihood of chronic opioid exposure included more recent index year, younger age, female sex, non-Hispanic Black race/ethnicity, rural residence, being underweight or obese, former/current smoking, greater comorbidity, urate-lowering therapy receipt, and requirement of rheumatology consultation.

Conclusion: Patients with gout are more likely to receive chronic opioids than non-gout counterparts, independent of other factors. This risk is greater in underrepresented gout populations, those with greater comorbidity, patients requiring rheumatology consultations and individuals prescribed urate-lowering treatments. Additional investigation is needed to elucidate whether deployment of optimal gout management minimizes chronic opioid exposure in patients with gout.