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Incidence of Long-term Opioid Use Among Opioid-Naive Patients With Hidradenitis Suppurativa in the United States

Educational Objective
To identify the incidence of long-term opioid use among opioid-naïve patients with hidradenitis suppurativa (HS).
1 Credit CME
Key Points

Question  What is the incidence of long-term opioid use among previously opioid-naive patients with hidradenitis suppurativa, and does it differ from that of patients without the condition?

Findings  In this cohort study of 22 277 patients with hidradenitis suppurativa, overall crude 1-year incidence of long-term opioid use was twice (0.33%) that among control patients (0.14%). The risk of long-term opioid use was 53% greater among patients with hidradenitis suppurativa after controlling for relevant confounders.

Meaning  These results suggest that patients with hidradenitis suppurativa may benefit from periodic assessment of pain and screening for opioid misuse.


Importance  Risk of long-term opioid use among patients with hidradenitis suppurativa (HS), who experience pain that substantially impairs quality of life, is unknown to date.

Objective  To compare overall and subgroup incidence of long-term opioid use in a population of opioid-naive patients with HS and control patients.

Design, Setting, and Participants  This retrospective cohort study was based on a demographically heterogeneous population-based sample of more than 56 million unique patients from January 1, 2008, through December 10, 2018. Patients with HS (n = 22 277) and controls (n = 828 832) were identified using electronic health records data. Data were analyzed from December 13, 2018, through January 28, 2019.

Main Outcomes and Measures  The primary outcome was incident long-term opioid use.

Results  Among the 22 277 patients with HS, mean (SD) age was 40.8 (14.6) years, 16 912 (75.9%) were women, and 13 190 (59.2%) were white. Crude 1-year incidence of long-term opioid use among opioid-naive patients with HS was 0.33% (74 of 22 277), compared with 0.14% (1168 of 828 832) among controls (P < .001). In adjusted analysis, patients with HS had 1.53 (95% CI, 1.20-1.95; P < .001) times the odds of new long-term opioid use compared with controls. Among patients with HS, advancing age (odds ratio [OR], 1.02 per 1-year increase; 95% CI, 1.00-1.03; P = .05), ever smoking (OR, 3.64; 95% CI, 2.06-6.41; P < .001), history of depression (OR, 1.97; 95% CI, 1.21-3.19; P = .006), and baseline Charlson comorbidity index score (OR, 1.15 per 1-point increase; 95% CI, 1.03-1.29; P = .01) were associated with higher odds of long-term opioid use. Among patients with HS and long-term opioid use, 4 of 74 (5.4%) were diagnosed with opioid use disorder during the study period. The most frequent schedule II opioid prescriptions included oxycodone hydrochloride (55 of 74 patients [74.3%]), hydrocodone bitartrate (44 [59.5%]), hydromorphone hydrochloride (16 [21.6%]), morphine sulfate (13 [17.6%]), and fentanyl citrate (6 [8.1%]). Tramadol hydrochloride (32 [43.2%]) represented the most frequent non–schedule II prescription. Disciplines prescribing the most opioids to patients with HS included primary care (398 [72.8%]), anesthesiology/pain management (48 [8.8%]), gastroenterology (25 [4.6%]), surgery (23 [4.2%]), and emergency medicine (10 [1.8%]).

Conclusions and Relevance  In this study, patients with HS were at higher risk for long-term opioid use. These results suggest that periodic assessment of pain and screening for long-term opioid use may be warranted, particularly among patients who are older, who smoke tobacco, or who have depression and other medical comorbidities.

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Article Information

Accepted for Publication: July 15, 2019.

Corresponding Author: Amit Garg, MD, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, Ste 300, New Hyde Park, NY 11042 (amgarg@northwell.edu).

Published Online: September 11, 2019. doi:10.1001/jamadermatol.2019.2610

Author Contributions: Mr Strunk and Dr Garg had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Reddy, Orenstein, Garg.

Critical revision of the manuscript for important intellectual content: Orenstein, Strunk, Garg.

Statistical analysis: Strunk.

Obtained funding: Garg.

Administrative, technical, or material support: Reddy.

Supervision: Garg.

Conflict of Interest Disclosures: Dr Orenstein reported receiving personal fees from Frontline Medical Communications and MedEd Consulting outside the submitted work. Dr Garg reported receiving grants and personal fees from from AbbVie and UCB during the conduct of the study, personal fees from Asana BioSciences, Pfizer Inc, Amgen, and Janssen Pharmaceutica, and grants from the National Psoriasis Foundation outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported in part by an education grant from AbbVie (Dr Garg).

Role of the Funder/Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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