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Opioids are not recommended for first-line use in chronic pain conditions such as OA and RA due to their limitations1,2*

In 2017, the U.S. Department of Health and Human Services declared a public health emergency due to the opioid epidemic.3 Opioid overdoses accounted for more than 42,000 deaths in 2016. Approximately 17,000 (40%) of these overdoses involved a prescription opioid.4

This epidemic continued into 2017 when approximately 11.1 million people misused prescription opioid pain relievers.5

OPIOID USE IS COMMON AMONG PATIENTS WITH OA AND RA

Between 2007 and 2014:

40%
of RA patients used opioids regularly6‡
17%
of OA patients were prescribed opioids for their condition

OPIOIDS DO NOT ADDRESS INFLAMMATION AND HAVE UNWANTED CONSEQUENCES

Opioid pain relievers:

  • Electricity
    Are not designed to target inflammation8-10
  • Person on toilet
    Can cause sedation, respiratory distress, and constipation11
  • neuron
    Act on the nervous system11
  • Rx pad
    Are controlled substances12
  • Medication
    Can cause addiction, dependence, and tolerance11

CDC GUIDELINES STATE THAT OPIOIDS SHOULD NOT BE CONSIDERED FIRST-LINE OR ROUTINE THERAPY FOR CHRONIC PAIN13*

Physicians should:

  • Use nonopioid therapies to the extent possible
  • Focus on functional goals and improvement, engaging patients actively in their pain management
  • Use first-line medication options preferentially

NSAIDs provide non-narcotic and non-addictive relief from the signs and symptoms of OA and RA, including inflammation and pain14-16

Make sure you prescribe the right NSAID

Consider the need for gastroprotection with NSAID therapy

See the data

Review the research on NSAID-related systemic exposure

Get the facts

*Non-opioid pharmacologic therapy options carry certain risks and may not be appropriate for certain patients; physicians should assess whether the benefits of non-opioid pharmacologic therapy outweigh the risk.

Outside of active cancer, palliative, and end-of-life care.1

Based on a longitudinal study of Medicare data (2006-2014, in the average rheumatologist’s practice).

§According to data from the Humana, Inc. administrative claims database.

CDC=Centers for Disease Control and Prevention; NSAID=nonsteroidal anti-inflammatory drug; OA=osteoarthritis; RA=rheumatoid arthritis.

REFERENCES

  1. Nonopioid treatments for chronic pain. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/pdf/nonopioid_treatments-a.pdf. Accessed January 15, 2019.
  2. Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf. Accessed January 25, 2019.
  3. What is the U.S. opioid epidemic? U.S. Department of Health and Human Services website. https://www.hhs.gov/opioids/about-the-epidemic/index.html. Published December 4, 2017. Accessed March 20, 2019.
  4. Seth P, Scholl L, Rudd RA, Bacon S. Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants — United States, 2015–2016. Morb Mortal Wkly Rep. 2018;67(12):349-358.
  5. 2017 NSDUH Annual National Report | CBHSQ. https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report. Accessed March 20, 2019.
  6. Curtis JR, Xie F, Smith C, et al. Changing trends in opioid use among patients with rheumatoid arthritis in the United States. Arthritis Rheumatol. 2017;69(9):1733-1740.
  7. DeMik DE, Bedard NA, Dowdle BS, et al. Are we still prescribing opioids for osteoarthritis? J Arthroplasty. 2017;32(12):3578-3582.
  8. Oxycontin (oxycodone hydrochloride) [package insert]. Stamford, CT: Purdue Pharma L.P.; September 2018.
  9. Vicodin (hydrocodone bitartrate andacetaminophen) [package insert]. North Chicago, IL: Abbvie Inc; December 2016.
  10. Pathan H, Williams J. Basic opioid pharmacology: an update. Br J Pain. 2012;6(1):11-16.
  11. Jamison RN, Mao J. Opioid. Mayo Clin Proc. 2015;90(7):957-968.
  12. Drug Enforcement Administration (DEA). Drug Fact Sheet. Narcotics. Drug Enforcement Agency website. https://www.dea.gov/druginfo/drug_data_sheets/Narcotics.pdf. Accessed March 21, 2018.
  13. Nonopioid treatments for chronic pain. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/pdf/nonopioid_treatments-a.pdf. Accessed January 15, 2019.
  14. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22(3):363-388.
  15. Crofford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15(suppl 3):S2.
  16. Stanos SP. Osteoarthritis guidelines: a progressive role for topical nonsteroidal anti-inflammatory drugs. J Multidiscip Healthc. 2013;6:133-137.