title: Prescription opioid use among older adults with arthritis or low back pain.
abstract: OBJECTIVE
  To examine patterns of chronic opioid use in selected groups with arthritis and low back pain and compare them with patterns among persons with ischemic heart disease.
  
  
  METHODS
  The study database consisted of Medicare beneficiaries who were enrolled in a drug benefit program for low-to-moderate income Pennsylvania residents. We identified selected patients who had a diagnosis of rheumatoid arthritis, osteoarthritis, chronic low back pain, or ischemic heart disease since 1995. Chronic opioid use, defined as at least six 30-day prescriptions in a year, was the endpoint of interest. We examined the proportion of patients meeting this definition during the period 1996-2001 and determined predictors based on multivariable Cox proportional hazards models.
  
  
  RESULTS
  Four percent of subjects with rheumatoid arthritis used opioids chronically in 2001, compared with <1% in each of the other groups. There was no increase in the chronic use of opioids over the 6-year study period. Low-potency opioids were the most commonly prescribed preparations for chronic users from all patient groups. The prior use of medicines for psychiatric illness, including benzodiazepines or barbiturates, was associated with chronic prescription opioid use across all diagnoses. However, subjects with a prior diagnosis of psychiatric illness were less likely to receive chronic opioids.
  
  
  CONCLUSIONS
  Chronic opioid use is relatively uncommon, even among older individuals with arthritis or low back pain. The proportion of these individuals receiving such medicines has not increased in the late 1990s. There seems to be a complex relationship between psychiatric medication use, psychiatric diagnoses, and the use of chronic opioids among these individuals.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Ste, 3030, Boston, MA 02120, USA. dhsolomon@partners.org
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wang
authors.forename: George
authors.initials: G
authors.lastname: Vaillant
authors.forename: Danielle
authors.initials: D
authors.lastname: Cabral
authors.forename: Helen
authors.initials: H
authors.lastname: Mogun
authors.forename: Til
authors.initials: T
authors.lastname: Stürmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002908:Chronic Disease; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017202:Myocardial Ischemia / Q000150:complications; D010003:Osteoarthritis / Q000150:complications*; D010414:Pennsylvania; D010818:Practice Patterns, Physicians'
chemical_list: D000701:Analgesics, Opioid