PMS20 Frequency of Initiating Pain Treatment with and Timing to Switching to Opioids Among Privately-Insured Patients with Osteoarthritis

Abstract

To manage pain associated with osteoarthritis (OA), opioids are frequently prescribed, although treatment guidelines typically do not recommend their use or recommend use of weak opioids (including tramadol) when alternatives fail. This study quantifies the frequency and timing of opioids as a treatment following an OA diagnosis. Among those opioid initiators, the study summarizes type of opioid use on initiation and characteristics relative to initiators of other drug treatments. The Optum Healthcare Solutions, Inc. data (1/2012-3/2017) were used to identify cancer-free adult patients with ≥2 diagnoses of hip and/or knee OA, and ≥30 days supply of commonly-used pain treatments during the three-year period from the date of their first drug use (index date) after the first OA diagnosis. Patients were required to be continuously-enrolled during the six months before and 36 months after the index date. Of the 52,770 patients meeting the inclusion criteria, 5,325 (10.1%) initiated treatment with opioids (including tramadol [2.6%] and non-tramadol opioids [7.5%]). Relative to initiators of other treatments, opioid initiators had more underlying comorbidities, had higher baseline healthcare costs, and were more likely to have OA of the hip. Finally, most users had an escalation to stronger medications to treat pain. Among initiators with tramadol, 66% eventually switched to non-tramadol opioids during the follow-up period. Among non-opioid initiators, 27% eventually switched to tramadol and 63% switched to non-tramadol opioids during the follow up. Further, the average duration of treatment prior to opioid initiation was 289 days. Despite risks of opioids, the results of this study demonstrate that a large percentage of patients with OA of the hip and/or knee either initiate on or eventually switch to use of prescription opioids for pain management. This highlights the need for new treatment options that delay or prevent use of opioids.