Opioids are not recommended for first-line use

in chronic pain conditions such as OA and RA due to their limitations^1,2*^†

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 over 47,000 deaths in 2017 alone; close to 17,000 (36%) of these involved a prescription opioid.⁴

2018 and 2019 opioid-specific mortality rates are still provisional, but it is estimated that over 130 people died every day from opioid-related drug overdoses.^3,4 In 2018, approximately 10 million people reported misuse of prescription pain relievers in the past year.⁴

^*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

OPIOID PREVALENCE

OPIOID USE IS COMMON AMONG PATIENTS WITH OA AND RA

In two studies that each compared >240,000 U.S. patients:

40%
of RA patients used opioids regularly^5‡

17%
of any joint OA patients were prescribed opioids for their condition^6§¶

^‡Based on a study of 2014 Medicare data in the average rheumatologist’s practice.
^§According to data from the Humana, Inc. administrative claims database from 2007 to 2014.
^¶13% of patients with hip OA and 16% of patients with knee OA were prescribed an opioid.
CDC=Centers for Disease Control and Prevention; DMARD=disease-modifying antirheumatic drug; NSAID=nonsteroidal anti-inflammatory drug; OA=osteoarthritis; RA=rheumatoid arthritis.

OPIOID LIMITATIONS

OPIOIDS DO NOT ADDRESS INFLAMMATION AND HAVE UNWANTED CONSEQUENCES

Opioid pain relievers:

Are not designed to target inflammation^7-9

Can cause sedation, respiratory distress, and constipation¹⁰

Act on the nervous system¹⁰

Are controlled substances¹¹

Can cause addiction, dependence, and tolerance¹⁰

EXPERT RECOMMENDATIONS

CDC GUIDELINES STATE THAT OPIOIDS SHOULD NOT BE CONSIDERED FIRST-
LINE OR ROUTINE THERAPY FOR CHRONIC PAIN¹*^†

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 pain^12-14

Low-dose prednisone is non-narcotic and can be added to DMARD therapy to provide relief from the signs and symptoms of RA, including inflammation and pain¹⁵

*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

Make sure you prescribe the right
therapy

Consider the need for gastroprotection with NSAID therapy

See the data

Review the research on NSAID-related systemic exposure

Get the facts

REFERENCES

Centers for Disease Control and Prevention. Nonopioid treatments for chronic pain. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/pdf/nonopioid_treatments-a.pdf. Accessed June 14, 2020.
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/prescribing/Guidelines_Factsheet-a.pdf. Accessed June 14, 2020.
U.S. Department of Health and Human Services. 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. Accessed June 14, 2020.
National Center for Injury Prevention and Control. Annual surveillance report of drug-related risks and outcomes. Centers for Disease Control and Prevention website. Published November 1, 2019. Available at: https://www.cdc.gov/drugoverdose/pdf/pubs/2019-cdc-drug-surveillance-report.pdf. Accessed June 14, 2020.
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.
DeMik DE, Bedard NA, Dowdle BS, et al. Are we still prescribing opioids for osteoarthritis? J Arthroplasty. 2017;32(12):3578-3582.
OXYCONTIN (oxycodone hydrochloride) [prescribing information] Purdue Pharma L.P.
NORCO (hydrocodone bitartrate and acetaminophen tablets) [prescribing information] Allergan USA, Inc.
Pathan H, Williams J. Basic opioid pharmacology: an update. Br J Pain. 2012;6(1):11-16.
Jamison RN, Mao J. Opioid. Mayo Clin Proc. 2015;90(7):957-968.
Drug Enforcement Administration (DEA). Drug Fact Sheet. Narcotics. Drug Enforcement Administration website. https://www.dea.gov/sites/default/files/2020-06/Narcotics-2020.pdf. Accessed June 14, 2020.
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non‐surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578‐1589.
Crofford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15(suppl 3):S2.
DUEXIS (ibuprofen and famotidine) [prescribing information] Horizon.
RAYOS (prednisone) delayed-release tablets [prescribing information] Horizon.