New European figures presented at EULAR 2020 show that increasingly more people are taking opioids for pain connected with rheumatic and musculoskeletal diseases, raising concern about addiction risks.

New analysis from Catalonia, Spain, shows that the consumption of opioids in patients with osteoarthritis (OA/arthrosis) in 2007 to 2016 increased from 15-to-25 per cent in all patients recorded. The survey is based on the health data (SIDIAP, System for the Development of Research in Primary Care) of 80 per cent of the population of the Spanish autonomous region, which is roughly six million patients. 

EULAR highlighted in the course of the Congress the growing risk of opioid abuse in Europe and called for measures to use these analgesics more safely. Around 70 per cent of opioids are prescribed in Germany for patients with chronic non-tumour associated pains. According to guidelines, they can, inter alia, be used for chronic osteoarthritis (arthrosis) pain for a four-to-12-week course of therapy. “There is an adequate scientific evidence basis for effectiveness and safety for this indication,” said Prof Ulf Müller-Ladner, EULAR Past Chair of the Standing Committee on Clinical Affairs and Medical Director of the Rheumatology and Clinical Immunology Department of the Kerckhoff Klinic in Bad Nauheim, Germany. Then, however, they should stop being taken, as these pain relievers have strong side-effects. However, the greatest risk is their effects on the central nervous system, which are sometimes mood-enhancing and sometimes levelling effects. “This accounts for their strong addiction potential: For most patients, the physical withdrawal is therefore the most difficult,” according to Müller-Ladner, who is also former President of the German Rheumatology Society (DGRh).

Women (4 per cent more affected than men), the elderly (10 per cent more than young people) and socially disadvantaged individuals (6 per cent more affected compared to the most privileged groups of the population) were shown to have a particular risk for addiction/dependency on opioids in the Catalonia study. 

Similarly, 1 per cent more rural residents take opioids compared to urban residents. Mr Junqing Xie from the University of Oxford, and lead author of the study, said: “Taking opioids, in particular strong opioids, has substantially increased in recent years in patients newly suffering from osteoarthritis.” 

Precautions must urgently be taken so that these medications are prescribed safely, EULAR said. This applies in particular for older women who live under difficult social conditions. 

Furthermore, a current study from Iceland shows that the taking of opioids is frequently not discontinued even after the source of pain has gone, but rather their consumption actually increases. Therefore, in patients with inflammatory joint diseases, the dose of their opioids actually increases, instead of them being discontinued, even after treatment with precise, effective anti-inflammatory agents, such as TNF inhibitors. “It is a matter of urgency,” said EULAR President Prof Iain B McInnes from Glasgow, Scotland. Opioid addiction has now become a significant problem there.

The risk of physical and psychological addiction development is, however, low when opioids are used as intended. “Therefore, we would like to raise awareness of a responsible approach, both by the prescribers and also the patients,” said Prof John Isaacs, University of Newcastle, UK, EULAR Scientific Committee Chair.