Women with endometriosis fill prescriptions for opioids, with or without benzodiazepines, more commonly than those without this disorder, according to new research in the U.S. The findings also revealed higher doses and longer periods of opioid use among endometriosis patients.
The study, “Patterns of Prescription Opioid Use in Women With Endometriosis Evaluating Prolonged Use, Daily Dose, and Concomitant Use With Benzodiazepines,” appeared in the journal Obstetrics & Gynecology.
In women, opioid abuse usually starts with a medical prescription for chronic pain, or to manage postoperative pain — both experienced by endometriosis patients. However, data on opioid use in this patient population are still scarce.
A team from AbbVie, University of Central Florida, Yale School of Medicine, and Yale New Haven Hospital addressed the prevalence of opioid use in endometriosis patients. The researchers also analyzed used doses, treatment duration, and the associated use of benzodiazepines, which may boost opioids’ efficacy.
The AbbVie-funded study further determined the timing of the first opioid prescription in relation to events such as the the disorder’s diagnosis, outpatient visits, or endometriosis-related surgery.
A total 53,847 women with endometriosis, diagnosed between January 2006 through December 2016, and 107,694 controls were identified in the large Optum Clinformatics Data Mart database. The patients’ mean age was 38 years (range 18–49 years), 62.4% were white, and 51.6% lived in the South. All participants had insurance coverage.
Women with endometriosis had higher rates of arthritis or joint pain (36.8% vs. 27.1%), and back or neck pain (28.6% vs. 19.2%), as compared with women in the control group. They also had mental disorders (20.7% vs. 14.6%), anxiety (13.4% vs. 9.2%), and episodic mood disorders (12.9% vs. 8.7%) more frequently than the controls.
Importantly, the results showed that, compared with the control group, endometriosis patients were more likely to fill at least one (79.3% vs. 24.2%), and multiple prescriptions for opioids (40.3% vs 10.5%), especially acetaminophen-hydrocodone bitartrate (43.2% vs 14.8%) and acetaminophen-oxycodone hydrochloride (36.4 vs 5.5%).
Women with endometriosis also more commonly filled prescriptions with a daily dose of 50 morphine milligram equivalents or higher (45.6% vs. 9.7%) or 100 morphine milligram equivalents or higher (14.9% vs. 3.3%). The endometriosis patients also were more likely to use opioids for 31–59 days (4.2% vs. 1.1%), 60–89 days (1.5% vs. 0.5%), or 90 days or longer (5.5% vs. 2.5%) than the control patients.
“This is a concerning finding because research has shown no therapeutic benefit of long-term opioid use in the treatment of noncancer pain,” the researchers said. “Furthermore, long-term opioid use has been associated with physical dependence, increased tolerance, opioid addiction, and adverse events.”
The women with endometriosis also were more likely to have both opioid and benzodiazepine prescriptions (10.1% vs. 3.5%) and to use both treatments for at least 30 days (3.0% vs. 1.2%), or at least 90 days (1.6% vs. 0.7%). Excluding opioid prescriptions filled within 30 days after surgery did not significantly alter the results.
More than one quarter of patients (26.8%) filled their first opioid prescription within seven days of their first claim for endometriosis. Also, 76.2% of the patients who started on opioids after diagnosis filled such prescriptions within seven days of an endometriosis-related surgery.
“Women with endometriosis had higher probabilities of prolonged use of opioids and concomitant use with benzodiazepines compared with women without this condition,” the team added. “Our findings emphasize the need for better health care provider education and appropriate patient selection and counseling before selecting opioids for pain management.”
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