BACKGROUND It is crucial to identify patients at highest risk for opioid use disorder (OUD) and to address challenges in reducing opioid use . Reported non-steroidal anti-inflammatory drug (NSAID) allergies may predispose to use of stronger pain medications and potentially to OUD .
OBJECTIVE Investigate the clinical impact of reported NSAID allergy on OUD in patients with chronic back pain.
METHODS We conducted a retrospective study of adults receiving care at a tertiary healthcare system from 1/1/2013-12/31/2018 . Back pain and OUD were identified using administrative data algorithms . We used propensity score matching and logistic regression to estimate the impact of self-reported NSAID adverse drug reactions (ADRs) on risk of OUD, adjusting for other relevant clinical information .
RESULTS Of 47,114 patients with chronic back pain, 3,620 (7.7 %) had a reported NSAID ADR . In an adjusted propensity score matched analysis, patients with NSAID ADRs had higher odds (OR 1.34 [95% CI 1.07-1.67] ) of developing OUD as compared to those without NSAID ADRs . Additional risk factors for OUD included younger age, male sex, Medicaid insurance, Medicare insurance, higher number of inpatient and outpatient visits in the prior year, and co-morbid anxiety and depression . Patients with listed NSAID ADRs also had higher odds of a documented opioid prescription during the study period (OR 1.22 [95% CI 1.11-1.34] ).
CONCLUSION Adults with chronic back pain and reported NSAID ADRs are at higher risk of developing OUD and receiving opioid analgesics, even after accounting for co-morbidities and health care utilization . Allergy evaluation is critical for potential de-labeling of patients with reported NSAID allergies and chronic pain.