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Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017.
Rheumatology (Oxford). 2021 04 06; 60(4):1942-1950.R

Abstract

OBJECTIVES

To produce national and regional estimates and trends for gabapentinoid-opioid co-prescribing rates in patients with OA, both in absolute terms and relative to matched controls without OA.

METHODS

Using the UK Clinical Practice Research Datalink database we first constructed age-sex-practice-date 1:1 matched cohorts of patients aged ≥40 years with and without a new diagnosis of OA between 1995-2017 and estimated the relative incidence of a first gabapentinoid prescription. Incident gabapentinoid users in both cohorts were followed to estimate and compare the event rate of gabapentinoid-opioid co-prescription (prescription from both classes within the same 28-day window).

RESULTS

The incidence of first gabapentinoid prescription was 3-fold higher in patients with OA than in matched controls [n = 215 357; incidence rate ratio (IRR) 2.93; 95% CI: 2.87, 3.00]. Among incident gabapentinoid users with OA (n = 27 374, median follow-up 3.9 years) the event rate of gabapentinoid-opioid co-prescription was 4.03 (4.02-4.05) per person-year. The rate was higher in OA patients classed as long-term gabapentinoid users (6.24; 6.22-6.26). These rates were significantly higher than in incident gabapentinoid users without OA [adjusted-IRR: 1.29 (1.28-1.30)]. This elevated risk was observed across age, sex, geographic regions, and calendar years, when restricted to strong opioids and to long-term gabapentinoid users, and when co-prescription was defined as within 14 days and same-day prescribing.

CONCLUSIONS

Patients with OA not only have a higher risk of being prescribed a gabapentinoid but, once prescribed a gabapentinoid, are also at greater risk of opioid co-prescription. Strict restriction of gabapentinoid-opioid co-prescription, and improved access to, and uptake of, effective non-pharmacological and surgical alternatives for OA are required.

Authors+Show Affiliations

Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK.Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK.Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK.Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33159800

Citation

Yu, Dahai, et al. "Co-prescription of Gabapentinoids and Opioids Among Adults With and Without Osteoarthritis in the United Kingdom Between 1995 and 2017." Rheumatology (Oxford, England), vol. 60, no. 4, 2021, pp. 1942-1950.
Yu D, Appleyard T, Cottrell E, et al. Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017. Rheumatology (Oxford). 2021;60(4):1942-1950.
Yu, D., Appleyard, T., Cottrell, E., & Peat, G. (2021). Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017. Rheumatology (Oxford, England), 60(4), 1942-1950. https://doi.org/10.1093/rheumatology/keaa586
Yu D, et al. Co-prescription of Gabapentinoids and Opioids Among Adults With and Without Osteoarthritis in the United Kingdom Between 1995 and 2017. Rheumatology (Oxford). 2021 04 6;60(4):1942-1950. PubMed PMID: 33159800.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017. AU - Yu,Dahai, AU - Appleyard,Tom, AU - Cottrell,Elizabeth, AU - Peat,George, PY - 2020/04/07/received PY - 2020/08/12/revised PY - 2020/11/8/pubmed PY - 2021/7/1/medline PY - 2020/11/7/entrez KW - gabapentinoid KW - gabapentinoid–opioid co-prescription KW - opioid KW - osteoarthritis SP - 1942 EP - 1950 JF - Rheumatology (Oxford, England) JO - Rheumatology (Oxford) VL - 60 IS - 4 N2 - OBJECTIVES: To produce national and regional estimates and trends for gabapentinoid-opioid co-prescribing rates in patients with OA, both in absolute terms and relative to matched controls without OA. METHODS: Using the UK Clinical Practice Research Datalink database we first constructed age-sex-practice-date 1:1 matched cohorts of patients aged ≥40 years with and without a new diagnosis of OA between 1995-2017 and estimated the relative incidence of a first gabapentinoid prescription. Incident gabapentinoid users in both cohorts were followed to estimate and compare the event rate of gabapentinoid-opioid co-prescription (prescription from both classes within the same 28-day window). RESULTS: The incidence of first gabapentinoid prescription was 3-fold higher in patients with OA than in matched controls [n = 215 357; incidence rate ratio (IRR) 2.93; 95% CI: 2.87, 3.00]. Among incident gabapentinoid users with OA (n = 27 374, median follow-up 3.9 years) the event rate of gabapentinoid-opioid co-prescription was 4.03 (4.02-4.05) per person-year. The rate was higher in OA patients classed as long-term gabapentinoid users (6.24; 6.22-6.26). These rates were significantly higher than in incident gabapentinoid users without OA [adjusted-IRR: 1.29 (1.28-1.30)]. This elevated risk was observed across age, sex, geographic regions, and calendar years, when restricted to strong opioids and to long-term gabapentinoid users, and when co-prescription was defined as within 14 days and same-day prescribing. CONCLUSIONS: Patients with OA not only have a higher risk of being prescribed a gabapentinoid but, once prescribed a gabapentinoid, are also at greater risk of opioid co-prescription. Strict restriction of gabapentinoid-opioid co-prescription, and improved access to, and uptake of, effective non-pharmacological and surgical alternatives for OA are required. SN - 1462-0332 UR - https://www.unboundmedicine.com/medline/citation/33159800/Co_prescription_of_gabapentinoids_and_opioids_among_adults_with_and_without_osteoarthritis_in_the_United_Kingdom_between_1995_and_2017_ L2 - https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/keaa586 DB - PRIME DP - Unbound Medicine ER -