Opioid-naive patients with hidradenitis suppurativa (HS) are at a higher risk for long-term opioid use compared with controls, a study in JAMA Dermatology suggests.

The study was a retrospective analysis of medical records, laboratories, practice management systems, and claims systems that included >56 million patients between 2008 and 2018. Researchers identified opioid-naive patients with HS (n=22,277) and controls without HS (n=828,832). The incidence of long-term opioid use (ie, ≥10 opioid prescriptions within a 1-year follow-up period) comprised the primary outcome. A secondary analysis to identify factors associated with long-term opioid use was also performed.

Patients with HS had greater odds of new long-term opioid use compared with controls (0.33% vs 0.14%, respectively; odds ratio [OR], 1.53; 95% CI, 1.20-1.95; P <.001), according to the adjusted analysis. Factors associated with long-term opioid use in patients with HS included advancing age (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), depression history (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).

Approximately 5.4% (n=4) of the 74 patients with HS and long-term opioid use were diagnosed with opioid use disorder. Opioids most frequently prescribed in this cohort were oxycodone hydrochloride (74.3%), hydrocodone bitartrate (59.5%), hydromorphone hydrochloride (21.6%), morphine sulfate (17.6%), fentanyl citrate (8.1%), and meperidine hydrochloride (6.8%). The most frequently prescribed non-schedule II opioid was tramadol hydrochloride (43.2%). Primary care physicians were most likely to prescribe opioids (72.8%) vs physicians disciplined in anesthesiology/pain management (8.8%), gastroenterology (4.6%), surgery (4.2%), and emergency medicine (1.8%).

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Limitations of the study include its retrospective nature as well as the lack of assessment of the impact of disease severity on long-term opioid use.

“Although modest in absolute value, the incidence of long-term opioid use among patients with HS was double that of the control population,” it was noted. As patients with HS had 53% greater risk for long-term opioid use than those without the disease (after accounting for demographic and clinical covariates), the researchers hope “that the medical community, including dermatologists, will further embrace and engage in an integrated care plan that comprehensively supports the needs of patients with HS, including pain management.”

Disclosure: This clinical trial was supported by AbbVie. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Reddy S, Orenstein LAV, Strunk A, Garg A. Incidence of long-term opioid use among opioid-naive patients with hidradenitis suppurativa in the United States [published online September 11, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.2610