Gout Patients Face Elevated Risk for Chronic Opioid Exposure
Veterans with gout were 30% more likely to be prescribed chronic opioid therapy than those without gout, with factors such as female sex, underweight BMI, current smoking status, and a higher burden of comorbidities increasing this likelihood.
METHODOLOGY:
Researchers conducted a matched cohort study to determine whether patients with gout were more likely than matched control individuals without gout to have a risk for chronic prescription opioid exposure.
They also sought to identify the clinical factors associated with chronic opioid exposure.
Data related to 419,967 patients with gout and 3,609,382 matched control individuals from the Veterans Health Administration (VHA) records (January 2000-July 2020) were included (overall mean age, 67.6 years; 99% men).
Chronic opioid exposure was defined as at least 90 days' cumulative supply from two or more pharmacy dispensing episodes occurring in a 6-month window without a gap of 32 or more days. Patients were followed up for a mean duration of 4.52 years.
Medications such as acetaminophen/hydrocodone, buprenorphine, codeine, fentanyl, hydromorphone, morphine, methadone, oxycodone, and tramadol were considered as opioids.
TAKEAWAY:
Patients with gout were 30% more likely than control individuals to receive prescriptions for chronic opioid use (adjusted hazard ratio [aHR], 1.30; 95% CI, 1.28-1.32).
Among patients with gout, factors associated with an increased likelihood of chronic opioid exposure included female sex (aHR, 1.29; 95% CI, 1.14-1.46), underweight BMI (aHR, 1.32; 95% CI, 1.13-1.54), and current smoking status (aHR, 1.62; 95% CI, 1.55-1.68).
Additional risk factors included requiring rheumatology consultation (aHR, 1.60; 95% CI, 1.54-1.66), receiving urate-lowering therapy (aHR, 1.30; 95% CI, 1.27-1.34), and having a higher Rheumatic Disease Comorbidity Index score (aHR, 1.26; 95% CI, 1.25-1.27).
Overweight BMI, the presence of chronic kidney disease, and evidence of adequate serum urate control were factors associated with a lower risk for chronic opioid exposure.
IN PRACTICE:
'In conclusion, we found in the VHA that patients with gout were more likely than those without gout to be prescribed opioids leading to chronic use after accounting for other possible determinants of receipt,' the study authors wrote.
'This study also identified several factors that appear to identify patients with gout at highest risk of receipt, factors that might ultimately be used in targeted efforts to reduce long-term prescription opioid use in this population,' they added.
SOURCE:
The study was led by Lindsay N. Helget, MD, Veterans Affairs Nebraska-Western Iowa Health Care System in Omaha, Nebraska, and was published online on August 4, 2025, in Arthritis Care and Research.
LIMITATIONS:
Administrative data restrictions prevented reliable identification of both the indication and specialty origin for index prescriptions. The predominantly male population may limit the generalizability of the findings. Reliance on algorithms leveraging administrative data could have led to misclassification of gout status and chronic opioid exposure.
DISCLOSURES:
This study was supported by a Scientist Development Award from the Department of Internal Medicine at the University of Nebraska Medical Center. Some authors received support or grants from Veterans Affairs Clinical Science Research & Development, the Rheumatology Research Foundation, the National Institutes of Health, Veterans Affairs, the US Department of Defense. Some authors reported receiving grants or contracts and/or consulting fees from various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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TOPLINE: Veterans with gout were 30% more likely to be prescribed chronic opioid therapy than those without gout, with factors such as female sex, underweight BMI, current smoking status, and a higher burden of comorbidities increasing this likelihood. METHODOLOGY: Researchers conducted a matched cohort study to determine whether patients with gout were more likely than matched control individuals without gout to have a risk for chronic prescription opioid exposure. They also sought to identify the clinical factors associated with chronic opioid exposure. Data related to 419,967 patients with gout and 3,609,382 matched control individuals from the Veterans Health Administration (VHA) records (January 2000-July 2020) were included (overall mean age, 67.6 years; 99% men). Chronic opioid exposure was defined as at least 90 days' cumulative supply from two or more pharmacy dispensing episodes occurring in a 6-month window without a gap of 32 or more days. Patients were followed up for a mean duration of 4.52 years. Medications such as acetaminophen/hydrocodone, buprenorphine, codeine, fentanyl, hydromorphone, morphine, methadone, oxycodone, and tramadol were considered as opioids. TAKEAWAY: Patients with gout were 30% more likely than control individuals to receive prescriptions for chronic opioid use (adjusted hazard ratio [aHR], 1.30; 95% CI, 1.28-1.32). Among patients with gout, factors associated with an increased likelihood of chronic opioid exposure included female sex (aHR, 1.29; 95% CI, 1.14-1.46), underweight BMI (aHR, 1.32; 95% CI, 1.13-1.54), and current smoking status (aHR, 1.62; 95% CI, 1.55-1.68). Additional risk factors included requiring rheumatology consultation (aHR, 1.60; 95% CI, 1.54-1.66), receiving urate-lowering therapy (aHR, 1.30; 95% CI, 1.27-1.34), and having a higher Rheumatic Disease Comorbidity Index score (aHR, 1.26; 95% CI, 1.25-1.27). Overweight BMI, the presence of chronic kidney disease, and evidence of adequate serum urate control were factors associated with a lower risk for chronic opioid exposure. IN PRACTICE: 'In conclusion, we found in the VHA that patients with gout were more likely than those without gout to be prescribed opioids leading to chronic use after accounting for other possible determinants of receipt,' the study authors wrote. 'This study also identified several factors that appear to identify patients with gout at highest risk of receipt, factors that might ultimately be used in targeted efforts to reduce long-term prescription opioid use in this population,' they added. SOURCE: The study was led by Lindsay N. Helget, MD, Veterans Affairs Nebraska-Western Iowa Health Care System in Omaha, Nebraska, and was published online on August 4, 2025, in Arthritis Care and Research. LIMITATIONS: Administrative data restrictions prevented reliable identification of both the indication and specialty origin for index prescriptions. The predominantly male population may limit the generalizability of the findings. Reliance on algorithms leveraging administrative data could have led to misclassification of gout status and chronic opioid exposure. DISCLOSURES: This study was supported by a Scientist Development Award from the Department of Internal Medicine at the University of Nebraska Medical Center. Some authors received support or grants from Veterans Affairs Clinical Science Research & Development, the Rheumatology Research Foundation, the National Institutes of Health, Veterans Affairs, the US Department of Defense. Some authors reported receiving grants or contracts and/or consulting fees from various sources. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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