SS07. Association of Opioid Abuse and Peripheral Arterial Disease

Abstract

Prescription opioids account for 40% of all U.S. opioid overdose deaths, and national efforts have intensified to reduce opioid prescriptions. However, little is known about the relationship between peripheral arterial disease (PAD) and high-risk opioid use. The objectives of this study were to evaluate the relationship between PAD and high opioid use and to assess whether PAD treatment has an impact on high opioid use. We used the 2007 to 2015 Truven Marketscan database, a deidentified national private insurance claims database, to identify patients with two International Classification of Diseases, Ninth Revision diagnosis codes of PAD 2 months apart with at least 2 years of continuous enrollment. Critical limb ischemia (CLI) was defined as rest pain, ulcers, or gangrene. Our primary outcome was high opioid use, defined as two opioid prescriptions within a 1-year period. Opioid prescriptions were excluded if they were filled within 90 days of a PAD-related procedure, identified by Current Procedural Terminology codes for lower extremity open/endovascular revascularization or amputation. A total of 182,186 patients with PAD met the inclusion criteria, 27.1% of whom had CLI. Mean (standard deviation) follow-up was 5.29 (2.13) years. An average of 24.4% of patients with PAD met the high opioid use criteria in any given calendar year, with a decreasing trend for patients meeting criteria beginning in 2010 (P < .01; Fig). Of high opioid users, 26.0% continued to meet criteria for 5 years. High opioid use was more common for patients with CLI (32.2% vs 21.4%; P < .01). During years of high opioid use, 5.9 ± 5.3 yearly prescriptions were filled. By multivariate analysis, illicit drug use and back pain were the strongest predictors of high opioid use (P < .001; Table). A new diagnosis of PAD increased high opioid use (21.3% before PAD diagnosis vs 26.9% after PAD diagnosis; P < .01). This association was seen for patients without CLI (20.2% to 24.1%; P < .01) and with CLI (27.5% to 37.7%; P < .01). A total of 45,028 patients (24.7%) underwent 88,229 PAD-related procedures. After exclusion of periprocedural opioid prescriptions (18% of all opioid prescriptions), the yearly percentage of high opioid users increased from 25.6% before treatment to 29.2% after treatment (P < .01). Patients with PAD are at increased risk for high opioid use, with nearly one-quarter meeting described criteria. CLI additionally increases opioid use. PAD treatment does not appear to decrease high opioid use. In addition to heightened awareness and active opioid management, our findings warrant further investigation into causes and deterrence of high-risk opioid useTableMultivariate analysis of factors independently associated with high opioid use for patients with peripheral arterial disease (PAD)Odds ratio95% CIP valueOsteoarthritis1.651.61-1.69<.001Joint pain1.671.63-1.71<.001Rheumatoid arthritis1.101.05-1.15<.001Migraine1.341.28-1.40<.001Abdominal pain1.301.27-1.33<.001Back pain1.851.81-1.89<.001Neck pain1.241.21-1.27<.001Tobacco use1.661.62-1.70<.001Alcohol use1.161.10-1.22<.001Illicit drug use1.921.76-2.09<.001Depression1.611.57-1.65<.001CI, Confidence interval.Adjusted for age, sex, and comorbidity using the Charlson Comorbidity Index. Open table in a new tab