OBJECTIVES: There is significant need to examine opioid prescribing for pain management in rheumatoid arthritis (RA) amid the opioid epidemic. The objectives of this study were to examine the patterns in opioid prescribing practices and the factors associated with receiving opioid prescriptions among outpatients with RA.

METHODS: This retrospective cross-sectional study used National Ambulatory Medical Care Survey (NAMCS) data from 2011 to 2016 involving adults (age>=18 years) with primary diagnosis of RA identified using International Classification of Diseases (ICD-9-CM and ICD-10-CM) codes. Opioid medications were identified using American Hospital Formulary Service classification and Multum Lexicon codes. Descriptive weighted analyses were used to examine the trends in opioid prescribing practices for RA. Multivariable logistic regression was used to examine the factors associated with receiving opioid prescriptions among RA visits.

RESULTS: Overall, there were 4.45 (95% CI, 2.30-6.60) million adult outpatient visits annually with a primary diagnosis of RA. About one in five visits (21.53%) resulted in opioid prescriptions. The number of RA visits involving opioid prescriptions increased from 1.26 million in 2011-2012 to 3.69 million in 2015-2016 (P<0.001). Being in the age group of 50-64 years (OR=3.57; 95% CI, 1.34-9.50), and visiting primary physician (OR=4.13; 95% CI, 1.64-10.43) were associated with a greater likelihood of opioid prescriptions. The use of comedications, including muscle relaxants (OR=68.00; 95% CI, 10.12-454.95), acetaminophen (OR=76.78; 95% CI, 22.89-257.71), antidepressants (OR=6.31; 95% CI, 2.72-14.66), and glucocorticoids (OR=3.13; 95% CI, 1.56-6.30) were also associated with increased likelihood of receiving opioid prescriptions.

CONCLUSIONS: Opioid prescribing for RA-related pain increased significantly from 2011 to 2016. Several factors were associated with the prescription of opioids among RA visits. Understanding these underlying factors may help to devise strategies for safe opioid prescribing practices in RA.