Association of opioid use and peripheral artery disease

• Published in: Journal of vascular surgery 2019-10, Vol.70 (4), p.1271-1279.e1
• Main Authors: Itoga, Nathan K., Sceats, Lindsay A., Stern, Jordan R., Mell, Matthew W.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Back Pain - diagnosis; Back Pain - drug therapy; Back Pain - epidemiology; Critical Illness; Databases, Factual; Drug Prescriptions; Endovascular Procedures - adverse effects; Female; Humans; Ischemia - diagnosis; Ischemia - epidemiology; Ischemia - therapy; Male; Middle Aged; Opioid-Related Disorders - diagnosis; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - prevention & control; Opioids; Percutaneous vascular intervention; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - epidemiology; Peripheral Arterial Disease - therapy; Peripheral artery disease; Prevalence; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; United States - epidemiology; Vascular Surgical Procedures - adverse effects
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2018.12.036

Prescription opioids account for 40% of all U.S. opioid overdose deaths, and national efforts have intensified to reduce opioid prescriptions. Little is known about the relationship between peripheral artery disease (PAD) and high-risk opioid use. The objectives of this study were to evaluate this relationship and to assess the impact of PAD treatment on opiate use. In this retrospective cohort study, the Truven Health MarketScan database (Truven Health Analytics, Ann Arbor, Mich), a deidentified national private insurance claims database, was queried to identify patients with PAD (two or more International Classification of Diseases, Ninth Revision diagnosis codes of PAD ≥2 months apart, with at least 2 years of continuous enrollment) from 2007 to 2015. Critical limb ischemia (CLI) was defined as the presence of rest pain, ulcers, or gangrene. The primary outcome was high opioid use, defined as two or more opioid prescriptions within a 1-year period. Multivariable analysis was used to determine risk factors for high opioid use. A total of 178,880 patients met the inclusion criteria, 35% of whom had CLI. Mean ± standard deviation follow-up time was 5.3 ± 2.1 years. An average of 24.7% of patients met the high opioid use criteria in any given calendar year, with a small but significant decline in high opioid use after 2010 (P < .01). During years of high opioid use, 5.9 ± 5.5 yearly prescriptions were filled. A new diagnosis of PAD increased high opioid use (21.7% before diagnosis vs 27.3% after diagnosis; P