Opioid Use Disorder and Treatment Uptake Among Patients With Rheumatic Conditions in the All of Us Research Program:...

Opioid use disorder (OUD) is associated with high morbidity and mortality. We aimed to describe the characteristics of patients with osteoarthritis (OA), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), or spondyloarthritis (SpA) who have OUD and to evaluate their uptake of medications for OUD (MOUDs).

Using the national All of Us Research Program (version 8), we identified individuals with at least two billing codes for SLE, RA, SpA, or OA. Patients with OUD were identified using at least one code for opioid dependence or abuse. We compared demographics, psychiatric disorders, prescription medications (opioids, glucocorticoids, and disease-modifying antirheumatic drugs [DMARDs]), comorbidities, and acute care use between patients with and without OUD. New MOUD use was defined by a prescription for methadone, buprenorphine, or naltrexone following the first OUD code in patients without prior MOUD use documented in available All of Us data.

Of 37,282 patients with rheumatic conditions, 1,502 (4%) had OUD. Patients with versus without OUD were younger and were more likely to have Medicaid insurance, psychiatric and medical comorbidities, and higher acute care use. They were more likely to have received prior prescription opioids (75.7% vs 45.8%) and glucocorticoids but less likely to have used biologic, targeted synthetic, or conventional DMARDs. Of the patients with rheumatic diseases and OUD, 14.5% received MOUDs.

Patients with rheumatic conditions and OUD exhibit distinct demographic and clinical characteristics including lower DMARD use and higher acute care use. MOUD uptake (14.5%) was significantly lower than national estimates (25%). Further research is needed to identify and address barriers to medication access in these patients.