Dr. Dahai Yu d.yu@keele.ac.uk
Objectives
To produce national and regional estimates and trends of gabapentinoid-opioid co-prescribing rates in patients with osteoarthritis, both in absolute terms and relative to matched controls without osteoarthritis.
Methods
Using the UK Clinical Practice Research Datalink database we first constructed age-sex-practice-date 1:1 matched cohorts of patients aged =40 years with and without a new diagnosis of osteoarthritis between 1995-2017 and estimated the relative incidence of first gabapentinoid prescription. Incident gabapentinoid users in both cohorts were followed to estimate and compare the event-rate of gabapentinoid-opioid co-prescription (prescription from both classes within the same 28-day window).
Results
The incidence of first gabapentinoid prescription was 3-fold higher in patients with osteoarthritis than in matched controls (n=215,357; incidence rate ratio (IRR) 2.93; 95%CI: 2.87-3.00). Among incident gabapentinoid users with osteoarthritis (n=27,374, median follow-up 3.9 years) the event-rate of gabapentinoid-opioid co-prescription was 4.03 (4.02-4.05) per person-year. The rate was higher in osteoarthritis patients classed as long-term gabapentinoid users (6.24; 6.22-6.26). These rates were significantly higher than incident gabapentinoid users without osteoarthritis (adjusted-IRR: 1.29 (1.28-1.30)). This elevated risk was observed across age, sex, geographic-regions, and calendar-years, when restricted to strong-opioids and to long-term gabapentinoid users, and when co-prescription was defined as within 14-days and same-day prescribing.
Conclusions
Patients with osteoarthritis not only have a higher risk of being prescribed a gabapentinoid but, once prescribed a gabapentinoid, are also at greater risk of opioid co-prescription. Strict restriction of gabapentinoid-opioid co-prescription, and improved access to, and uptake of, effective non-pharmacological and surgical alternatives for osteoarthritis are required.
Yu, Appleyard, T., Cottrell, E., & Peat, G. (2021). Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017. Rheumatology, 60(4), 1942-1950. https://doi.org/10.1093/rheumatology/keaa586
Journal Article Type | Article |
---|---|
Acceptance Date | Jul 18, 2020 |
Online Publication Date | Nov 7, 2020 |
Publication Date | 2021-04 |
Journal | Rheumatology |
Print ISSN | 1462-0324 |
Publisher | Oxford University Press |
Peer Reviewed | Peer Reviewed |
Volume | 60 |
Issue | 4 |
Pages | 1942-1950 |
DOI | https://doi.org/10.1093/rheumatology/keaa586 |
Keywords | gabapentinoid, opioid, gabapentinoid-opioid co-prescription, osteoarthritis |
Publisher URL | https://doi.org/10.1093/rheumatology/keaa586 |
Online Supplemental File 1 final clean copy.docx
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coprescription paperRheumatology fianl clean copy.docx
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https://creativecommons.org/licenses/by-nc/4.0/
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