Opioid Use on the Rise in Europe

German researchers reported at EULAR this week that patients with rheumatic and musculoskeletal-related pain are increasingly turning to opioids.

According to an analysis of opioid use in Catalonia, Spain from 2007 to 2016, patients with osteoarthritis increasingly turned to opioids to control pain. The use of this medication increased from 15 to 25 percent in all patients. The analysis is based on a review of records from approximately six million patients.

“The European League Against Rheumatism is indicating in the course of its annual European E-Congress of Rheumatology 2020 the growing risk of opioid abuse in Europe and calls for measures to use these analgesics more safely,” according to a statement issued by the organization which is holding its annual meeting this week virtually.

The authors of this study, who were led by Junqing Xie of the University of Oxford, wrote that  70 percent of opioids prescribed in Germany are done so to treat chronic non-tumor associated pains. But treatment guidelines allow their use for chronic osteoarthritis for a four- to 12-week course of therapy.

“There is an adequate, scientific evidence basis for effectiveness and safety for this indication,” said Dr. Ulf Müller-Ladner, who is past chair of EULAR’s Standing Committee on Clinical Affairs. He also serves as Medical Director of the Rheumatology and Clinical Immunology Department of the Kerckhoff Clinic in Bad Nauheim, Germany. His concern, though, is the potential for addiction.

In this study, women were more often affected than men by 4%. The elderly were 10% more affected than younger populations. And, people of lower socioeconomic status were affected 6% more than more privileged groups. And, rural residents were disproportionately affected by as much as 1% as compared to urban residents.

“Taking opioids, in particular strong opioids, has substantially increased in recent years in patients newly suffering from osteoarthritis,” Dr. Xie said in a statement issued by EULAR. He urges the need for precautions to safely prescribe these medications, in particular for at-risk groups.

A second study from Iceland, showed that patients continue to take opioids even after the source of pain is gone and their consumption increases even after being treated with anti-inflammatory agents such as TNF inhibitors.

“It is a matter of urgency,” said Dr. Iain B. McInnes of Glasgow, Scotland, and EULAR president.

When opioids are used as intended, the risk for addition is low said Dr. John Isaacs of the University of Newcastle, chair of the EULAR scientific committee.

“Therefore, we would like to raise awareness of a responsible approach both by the prescribers and also the patients,” he said. “In order to alleviate chronic pain, medications should in any case only be part of a comprehensive therapy program, in which doctors, psychologists and physiotherapists work together. If doctors prescribe opioids in exceptional situations, the therapy trial should swiftly end if it proves ineffective or the effect diminishes,” he said in a statement issued by EULAR.