Association of Opioid Use and Peripheral Arterial Disease

Two Sentences: Private insurance prescription records from 2007–2015 demonstrated nearly 25% of patients with PAD have high opioid use, defined as ≥2 opioid prescriptions in a given year. Patients undergoing treatment for PAD and those with a diagnosis of critical limb ischemia were at higher risk for high opioid utilization. ulcers or gangrene. The high opioid use, ≥2 opioid prescriptions Multi-variable analysis used determine risk factors for high opioid use. Results: A total of 178,880 patients met the inclusion criteria, 35% of whom had CLI. Mean ± SD follow-up time 5.3 ±2.1 years. An average of 24.7% of patients met the high opioid use criteria in any given calendar year, with a small but a significant decline in high opioid use after 2010 (P<0.01). diagnosis vs. 34.5% after diagnosis; P<0.001). Multi-variable analysis identified back pain (OR 1.89, 95% CI 1.84–1.93, P<0.001) and illicit drug use (OR 1.87, 95% CI 1.72–2.03, P<0.001) as the highest predictors of high opioid use. A diagnosis of CLI was also associated with higher risk (OR 1.61, 95% CI 1.57–1.64, P<0.001). A total of 43,443 PAD patients (24.3%) underwent 80,816 PAD related procedures. After excluding peri-procedural opioid prescriptions (4.9% of all opioid prescriptions), the yearly percentage of high opioid users increased from 25.8% pretreatment to 29.6% post-treatment (P<0.001). Conclusion: Patients with PAD are at increased risk for high opioid use, with nearly one-quarter meeting described criteria. CLI and treatment for PAD additionally increase high opioid utilization. In addition to heightened awareness and active opioid management, our findings warrant further investigation into underlying causes and deterrents of high-risk opioid use.