NSAID Allergy May Increase Risk for Opioid Use Disorder

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology annual meeting, taking place in San Francisco, California. Our staff will report on medical research related to asthma, allergy, and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI 2019.

SAN FRANSISCO — Patients with low back pain or osteoarthritis who reported adverse drug reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) have significantly higher odds of receiving prescriptions for opioids and developing opioid use disorder compared with patients without adverse reactions to NSAIDs, according to research presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting, held February 22-25, in San Francisco, California.

The use of NSAIDs as first-line treatment for chronic pain is advised to reduce the quantity and length of opioid prescriptions, which are associated with opioid use disorder and increased risk of overdose. This retrospective study of patients with low back pain or osteoarthritis being treated by the Partners HealthCare System from January 2008 to December 2017 was designed to assess the underexplored relationships between reported adverse reactions to NSAIDs, analgesic utilization patterns, and opioid use disorder.

Patients with reported adverse reactions to NSAIDs and opioid use disorder were identified by applying administrative data algorithms to information found in the electronic health record. Clinical characteristics, analgesic prescription information, and sociodemographic information were obtained.

In the population of patients with opioid use disorder and low back pain or osteoarthritis, 1.27% reported adverse drug reactions to NSAIDs. Compared with patients without adverse reactions to NSAIDs, patients with adverse reactions to NSAIDs have 1.94 times the odds of developing an opioid use disorder (95% CI, 1.65-2.28; P <.0001) and 4.98 times the odds of ever receiving a prescription for opioids (95% CI, 4.44-5.58; P <.0001). Blacks with adverse reactions to NSAIDs have 10.35 times the odds of receiving a prescription for opioids (95% CI, 5.50-19.51; P <.0001) compared with blacks without adverse reactions to NSAIDs.

“Targeted evaluation and intervention by allergy specialists is needed to help address safer pain management and improved care of NSAID-allergic patients,” the investigators concluded.

Reference

Li L, Laidlaw TM. Clinical impact of reported non-steroidal anti-inflammatory drug allergy on opioid use disorder in patients with osteoarthritis or low back pain. Presented at: 2019 American Academy of Allergy, Asthma & Immunology Annual Meeting; February 22-25, 2019; San Francisco, CA. Abstract 594.

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