Predictors of Chronic Opioid Use Among Women With Endometriosis [18J]

Stephanie E. Chiuve, Ryan D. Kilpatrick, Natalia Petruski‐Ivleva, Lani R. Wegrzyn, Michael C. Snabes, Brian T. Bateman
In: Obstetrics & Gynecology · 2019 · vol. 133(1) , pp. 111S–112S · doi:10.1097/01.aog.0000558834.25763.06 · W2944487632
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Fibromyalgia, back pain, migraines, tobacco use, antidepressants, antipsychotics, benzodiazepines, and prior opioid use predicted chronic opioid use in women with endometriosis.

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This study analyzed a US commercial insurance claims database to identify predictors of chronic opioid use among 39,513 women aged 18-50 with an initial diagnosis of endometriosis. Researchers defined chronic use as having ten or more fills or 120 days of coverage within a year and found that 4.4% of the cohort met this criterion over two years. Significant risk factors included prior opioid exposure, fibromyalgia, back pain, migraines, tobacco use, and concurrent prescriptions for antidepressants, antipsychotics, or benzodiazepines. This paper is centrally about endometriosis — specifically examining the prevalence and predictors of chronic opioid dependence in patients diagnosed with the condition.

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Abstract

INTRODUCTION: Women with endometriosis are prescribed opioids for pain relief but may have other risk factors for chronic opioid use. The identification of predictors of chronic use in this population may provide clinical guidance for treatment selection. METHODS: Women with an initial claim for endometriosis (N=39,513) aged 18-50 years were identified from a US commercial insurance claims database and followed for 2 years. Chronic opioid use was defined as ≥10 fills or ≥120 days covered in 365 days. Multivariable logistic regression models were used to identify potential predictors of chronic opioid use. RESULTS: Over 2 years, 4.4% of women with endometriosis became chronic opioid users. Risk factors for chronic use included fibromyalgia (OR 1.54; 95% CI 1.12-2.10), back pain (OR 1.42; 95% CI 1.15-1.75), migraines (OR 1.39; 95% CI 1.07-1.81), tobacco use (OR 1.56; 95% CI 1.22-2.00), antidepressants (OR 1.69; 95% CI 1.39-2.05), antipsychotics (OR 2.03; 95% CI 1.41-2.91), benzodiazepine (OR 1.57; 95% CI 1.27-1.94) and prior use of opioids (OR 4.83; 95% CI 4.02-5.81). These characteristics were more frequent in women with than without endometriosis: fibromyalgia (4% vs 2%), back pain (14% vs 8%), migraines (6% vs 2%), tobacco use (4% vs 2%), antidepressants (19% vs 13%), antipsychotics (2% vs 1%), benzodiazepine (11% vs 5%) and prior use of opioids (34% vs 13%) (p<0.01). CONCLUSION: Women with endometriosis who are exposed to opioids and are at high-risk for chronic opioid use may be identified based on comorbidities and concomitant medication use. Opioid prescribing should be carefully considered among high-risk women.
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Introduction

Women with endometriosis are prescribed opioids for pain relief but may have other risk factors for chronic opioid use. The identification of predictors of chronic use in this population may provide clinical guidance for treatment selection.

Methods

Women with an initial claim for endometriosis (N=39,513) aged 18-50 years were identified from a US commercial insurance claims database and followed for 2 years. Chronic opioid use was defined as ≥10 fills or ≥120 days covered in 365 days. Multivariable logistic regression models were used to identify potential predictors of chronic opioid use.

Results

Over 2 years, 4.4% of women with endometriosis became chronic opioid users. Risk factors for chronic use included fibromyalgia (OR 1.54; 95% CI 1.12-2.10), back pain (OR 1.42; 95% CI 1.15-1.75), migraines (OR 1.39; 95% CI 1.07-1.81), tobacco use (OR 1.56; 95% CI 1.22-2.00), antidepressants (OR 1.69; 95% CI 1.39-2.05), antipsychotics (OR 2.03; 95% CI 1.41-2.91), benzodiazepine (OR 1.57; 95% CI 1.27-1.94) and prior use of opioids (OR 4.83; 95% CI 4.02-5.81). These characteristics were more frequent in women with than without endometriosis: fibromyalgia (4% vs 2%), back pain (14% vs 8%), migraines (6% vs 2%), tobacco use (4% vs 2%), antidepressants (19% vs 13%), antipsychotics (2% vs 1%), benzodiazepine (11% vs 5%) and prior use of opioids (34% vs 13%) (p<0.01).

Conclusion

Women with endometriosis who are exposed to opioids and are at high-risk for chronic opioid use may be identified based on comorbidities and concomitant medication use. Opioid prescribing should be carefully considered among high-risk women.

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