ArticleThe Journal of rheumatology2026
Persistent Opioid Exposure in Older Adults with Rheumatic Disease: National Patterns, Disparities, and Cross-Specialty Prescribing.
Article in The Journal of rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
Funding
Abstract
objectiveEstimate national prevalence of opioid use, including chronic and high-risk use, among older adults with rheumatic diseases; identify sociodemographic and clinical factors associated with chronic opioid use; and characterize prescribing patterns by clinician specialty in a contemporary Medicare-linked national registry cohort.
methodsCross-sectional analysis of the Rheumatology Informatics System for Effectiveness (RISE) registry linked to Medicare Part D (2016-2021). Patients were ≥65 years with qualifying rheumatic diagnoses and continuous Medicare enrollment in 2021. Opioid use was identified from Part D claims. Chronic use was defined as ≥90 days' supply in 2021. High-risk use was assessed using Office of Inspector General indicators. Generalized estimating equations modeled factors associated with chronic opioid use.
resultsAmong 45,455 patients (mean age 75.8 years; 76.88% women), 43.13% filled ≥1 opioid prescription and 17.93% met criteria for chronic use in 2021. Very high-risk prescribing was rare (<1%). Chronic use was most prevalent in axial spondyloarthritis (axSpA; 26.19%) and least in polymyalgia rheumatica (11.58%). In adjusted analyses, axSpA (OR 1.63, 95% CI 1.35-1.98), fibromyalgia (OR 2.68, 95% CI 2.39-3.00), mood and anxiety disorders, higher comorbidity burden, American Indian/Alaska Native race, and greater socioeconomic deprivation were independently associated with chronic use. Non-rheumatology clinicians wrote most opioid prescriptions (62.60%) and more high-dose prescriptions (≥50 morphine milligram equivalents/day).
conclusionOpioid exposure remains common among Medicare-insured older adults with rheumatic disease, although very high-risk prescribing is rare. Coordinated, guideline-concordant pain management across specialties may help preserve appropriate opioid use for patients who may benefit while reducing avoidable long-term exposure.
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