Research Viewpoints Opioid Use in Hemodialysis Patients

Viewpoint on:

Daubresse M, Alexander GC, Crews D, Segev DL, McAdams-DeMarco MA: Trends in Opioid Prescribing Among Hemodialysis Patients, 2007–2014. Am J Nephrol 2019;49:20–31

The “opioid epidemic” in the USA is widely reported in many media sources, but data concerning trends in opioid use among patients with specific diseases, other than cancer, is rather sparse.

Daubresse and co-workers have remedied this deficit, in part, by examining opioid use in a longitudinal cohort study of 484,745 patients receiving hemodialysis (HD) therapy in the USA between 2007 and 2014. Opioid use in such patients is quite common — in 2007 62.4 % of patients received one or more opioid prescriptions. However, the rate of opioid prescriptions for HD patients decreased to 53.7 % after a peak in 2010. Opioid use was higher in non-Hispanics and lower-income persons. Not surprisingly, opioid use was more common in HD patients than in the general US population, but the decline in opioid use by HD patients over time outstripped that of the general US population. Chronic pain, of various types and origins, is common among HD patients, but it appears that policies to curb the use of opiates for pain relief are having an effect in both the general US population and in HD patients. Groups with highest opioid use in HD are patients aged 36 – 57 years, women, black, non-Hispanic, disabled, diabetic, and located in specific regions of the US. These data might be used to target educational programs to further curtail the inappropriate use of opioids. The market withdrawal of fentanyl in 2011 probably had an effect on opioid use.

The “opioid epidemic” probably extends to HD patients but it seems to be subsiding, at least in some groups of patients. But much more remains to be done to minimize the apparent over-utilization of these addictive agents in HD patients. Non-opioid pain relievers (e.g. non-steroidal anti-inflammatory agents with analgesic properties) might be under-utilized but this was not the focus of this analysis.