Incidence of Long-term Opioid Use among Opioid-Naive Patients with Hidradenitis Suppurativa in the United States

S. Reddy
L. A. Orenstein
A. Strunk
A. Garg, Zucker School of Medicine at Hofstra/Northwell

Abstract

© 2019 American Medical Association. All rights reserved. Importance: Risk of long-term opioid use among patients with hidradenitis suppurativa (HS), who experience pain that substantially impairs quality of life, is unknown to date. Objective: To compare overall and subgroup incidence of long-term opioid use in a population of opioid-naive patients with HS and control patients. Design, Setting, and Participants: This retrospective cohort study was based on a demographically heterogeneous population-based sample of more than 56 million unique patients from January 1, 2008, through December 10, 2018. Patients with HS (n = 22277) and controls (n = 828832) were identified using electronic health records data. Data were analyzed from December 13, 2018, through January 28, 2019. Main Outcomes and Measures: The primary outcome was incident long-term opioid use. Results: Among the 22 277 patients with HS, mean (SD) age was 40.8 (14.6) years, 16 912 (75.9%) were women, and 13 190 (59.2%) were white. Crude 1-year incidence of long-term opioid use among opioid-naive patients with HS was 0.33% (74 of 22 277), compared with 0.14% (1168 of 828 832) among controls (P <.001). In adjusted analysis, patients with HS had 1.53 (95% CI, 1.20-1.95; P <.001) times the odds of new long-term opioid use compared with controls. Among patients with HS, advancing age (odds ratio [OR], 1.02 per 1-year increase; 95% CI, 1.00-1.03; P =.05), ever smoking (OR, 3.64; 95% CI, 2.06-6.41; P <.001), history of depression (OR, 1.97; 95% CI, 1.21-3.19; P =.006), and baseline Charlson comorbidity index score (OR, 1.15 per 1-point increase; 95% CI, 1.03-1.29; P =.01) were associated with higher odds of long-term opioid use. Among patients with HS and long-term opioid use, 4 of 74 (5.4%) were diagnosed with opioid use disorder during the study period. The most frequent schedule II opioid prescriptions included oxycodone hydrochloride (55 of 74 patients [74.3%]), hydrocodone bitartrate (44 [59.5%]), hydromorphone hydrochloride (16 [21.6%]), morphine sulfate (13 [17.6%]), and fentanyl citrate (6 [8.1%]). Tramadol hydrochloride (32 [43.2%]) represented the most frequent non-schedule II prescription. Disciplines prescribing the most opioids to patients with HS included primary care (398 [72.8%]), anesthesiology/pain management (48 [8.8%]), gastroenterology (25 [4.6%]), surgery (23 [4.2%]), and emergency medicine (10 [1.8%]). Conclusions and Relevance: In this study, patients with HS were at higher risk for long-term opioid use. These results suggest that periodic assessment of pain and screening for long-term opioid use may be warranted, particularly among patients who are older, who smoke tobacco, or who have depression and other medical comorbidities.