Prescription Opioid Use in Patients With and Without Systemic Lupus Erythematosus — Michigan Lupus Epidemiology and Surveillance Program, 2014–2015

• Published in: MMWR. Morbidity and mortality weekly report 2019-09, Vol.68 (38), p.819-824
• Main Authors: Somers, Emily C., Lee, Jiha, Hassett, Afton L., Zick, Suzanna M., Harlow, Siobán D., Helmick, Charles G., Barbour, Kamil E., Gordon, Caroline, Brummett, Chad M., Minhas, Deeba, Padda, Amrita, Wang, Lu, McCune, W. Joseph, Marder, Wendy
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analgesics, Opioid - therapeutic use; Care and treatment; Central nervous system; Chronic kidney failure; Cohort Studies; Dexmedetomidine; Drug Prescriptions - statistics & numerical data; Emergency Service, Hospital; Epidemiology; Female; Fibromyalgia; Full Report; Humans; Kidney diseases; Lupus; Lupus erythematosus; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - epidemiology; Male; Michigan - epidemiology; Middle Aged; Opioids; Overdose; Pain management; Pain Management - methods; Population Surveillance; Risk; Somatoform disorders; Systemic lupus erythematosus
• ISSN: 0149-2195; 1545-861X
• DOI: 10.15585/mmwr.mm6838a2

Rheumatic diseases are a leading cause of chronic, noncancer pain. Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease characterized by periodic flares that can result in irreversible target organ damage, including end-stage renal disease. Both intermittent and chronic musculoskeletal pain, as well as fibromyalgia (considered a centralized pain disorder due to dysregulation of pain processing in the central nervous system), are common in SLE. Opioids are generally not indicated for long-term management of musculoskeletal pain or centralized pain (fibromyalgia) because of lack of efficacy, safety issues ranging from adverse medical effects to overdose, and risk for addiction (1,2). In this study of 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort and 192 frequency-matched persons without SLE, nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014-2015), compared with 8% of persons without SLE (p1 year, and 31 (22%) were concomitantly on two or more opioid medications. Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.6; p = 0.004). In SLE, the combined contributions of underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies already put patients at higher risk for some known adverse effects attributed to long-term opioid use. Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.