Predictors of Chronic Opioid Use Among Women With Endometriosis [18J]

INTRODUCTION: Women with endometriosis are prescribed opioids for pain relief but may have other risk factors for chronic opioid use. The identification of predictors of chronic use in this population may provide clinical guidance for treatment selection. METHODS: Women with an initial claim for endometriosis (N=39,513) aged 18-50 years were identified from a US commercial insurance claims database and followed for 2 years. Chronic opioid use was defined as ≥10 fills or ≥120 days covered in 365 days. Multivariable logistic regression models were used to identify potential predictors of chronic opioid use. RESULTS: Over 2 years, 4.4% of women with endometriosis became chronic opioid users. Risk factors for chronic use included fibromyalgia (OR 1.54; 95% CI 1.12-2.10), back pain (OR 1.42; 95% CI 1.15-1.75), migraines (OR 1.39; 95% CI 1.07-1.81), tobacco use (OR 1.56; 95% CI 1.22-2.00), antidepressants (OR 1.69; 95% CI 1.39-2.05), antipsychotics (OR 2.03; 95% CI 1.41-2.91), benzodiazepine (OR 1.57; 95% CI 1.27-1.94) and prior use of opioids (OR 4.83; 95% CI 4.02-5.81). These characteristics were more frequent in women with than without endometriosis: fibromyalgia (4% vs 2%), back pain (14% vs 8%), migraines (6% vs 2%), tobacco use (4% vs 2%), antidepressants (19% vs 13%), antipsychotics (2% vs 1%), benzodiazepine (11% vs 5%) and prior use of opioids (34% vs 13%) (p<0.01). CONCLUSION: Women with endometriosis who are exposed to opioids and are at high-risk for chronic opioid use may be identified based on comorbidities and concomitant medication use. Opioid prescribing should be carefully considered among high-risk women.