Opioid epidemic: Does rheumatological practice favors risk for patients? National survey on rheumatologists’ opioid prescriptions and compliance to guidelines for strong opioid prescription - 11/02/21
, Chouki Chenaf b, Marie Riquelme b, Emmanuel Curis c, Ioannis Nicolis c, Rose-Marie Javier d, Pascale Vergne-Salle e, Françoise Laroche f, Sophie Pouplin g, Nicolas Authier b, Serge Perrot aBienvenue sur EM-consulte, la référence des professionnels de santé.
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| pages | 7 |
| Iconographies | 2 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | Opioid prescription is a growing problem. In rheumatology, pain is the leading symptom, strong opioids are considered moderately effective and aren’t recommended for first-line treatment. |
• | Most rheumatologists abide by national recommendations. When prescribed, strong opioids are for short periods, with mean doses of 36 mg of morphine equivalent per day. |
• | In France, where long-standing recommendations formulated by rheumatologists are in place, the majority of national community of these specialists is aware of opioid prescription recommendations. |
• | The French example might help other countries in the midst of the opioid crisis. |
Abstract |
Objectives |
Given the scope of rheumatology and its prevalence of pain, it seems needed that a study should focus on prescription habits, in the midst of the international opioid epidemic and given the moderate efficacy of strong opioids in chronic musculoskeletal conditions. We compared rheumatologists’ opioid prescribing patterns in non-cancer pain with recommended practice.
Methods |
We performed a cross-sectional study of the French health insurance database, including all patients aged 16 years or over reimbursed for at least one strong opioid prescription from a rheumatologist in 2015. A nationwide survey of all registered rheumatologists in France was performed with a 47-item questionnaire in June 2015.
Results |
Only 2.4% of the patients receiving a strong opioid in 2015 (n=700,946) had at least one prescription from a rheumatologist. Rheumatologists prescribed mostly morphine, and significantly less oxycodone and fentanyl (P<0.00001) than other specialists. Rheumatologists prescribed a mean of 35.8mg morphine equivalent/day. A response rate of 33.7% was obtained to the questionnaire. Acute musculoskeletal pain was the principal condition for strong opioids prescription, with 94.5% re-evaluating opioid treatment within two weeks of initiation. For efficacy, 80% said that they stopped treatment if no benefit was observed after a test period (mean=1.2 months). Rheumatologists with pain management training were significantly more likely to evaluate pain before prescribing strong opioids (P=0.001), evaluate efficacy within three months (P=0.01) and screen for risk factors for misuse at initiation (P<0.0001).
Conclusions |
For non-cancer pain, rheumatologists generally prescribe opioids for short periods, at low doses, mostly according to national recommendations. Pain education strongly affected opioid prescription by rheumatologists.
Le texte complet de cet article est disponible en PDF.Keywords : Strong opioids, Rheumatology, Prescribing patterns, Non-cancer pain
Plan
Vol 88 - N° 1
Article 105046- janvier 2021 Retour au numéro
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