Long-term opioids in gout: A matched cohort study from the Veterans Health Administration

Abstract: Objective: Though used frequently to treat flare, risk of long-term opioid exposure in gout has not been well defined. In this study, we examined the hypothesis that people with gout are more likely than individuals without gout to be prescribed long-term opioids over time. Methods: In this matched cohort study using national Veterans Health Administration (VHA) data, multivariable Cox regression was used to examine the association of gout with long-term opioid receipt (defined using a validated administrative algorithm). Patients with gout were identified using diagnostic codes and matched with up to 10 controls without gout by age, sex, and VHA enrollment year. In analyses limited to gout, factors associated with long-term opioid exposure were identified. Results: Over a mean follow-up of 4.52 years, patients with gout were more likely to receive long-term opioids than controls (6.9% vs 3.8%). This risk remained following covariate adjustment (adjusted hazard ratio 1.30; 95% confidence interval 1.28-1.32). Among patients with gout, factors independently associated with an increased likelihood of long-term opioid exposure included more recent index year, younger age, female sex, non-Hispanic Black race and ethnicity, rural residence, being underweight or obese, former or current smoking, greater comorbidity, urate-lowering therapy receipt, and requirement of rheumatology consultation. Conclusion: Patients with gout are more likely to receive long-term opioids than counterparts without gout, independent of other factors. This risk is greater in underrepresented gout populations, those with greater comorbidity, patients requiring rheumatology consultations, and individuals prescribed urate-lowering treatments. Additional investigation is needed to elucidate whether deployment of optimal gout management minimizes long-term opioid exposure in patients with gout.