Gout Associated With Higher Risk of Long-Term Opioid Use in Veterans Cohort
Patients with gout are significantly more likely to receive long-term opioid prescriptions compared with individuals without gout, according to a large matched cohort study using national Veterans Health Administration data. The findings raise concerns about sustained opioid exposure in a disease where guideline-directed therapy emphasizes urate lowering and flare prevention.
Investigators conducted a matched cohort analysis of veterans with gout and up to 10 age-, sex-, and enrollment year–matched controls without gout. Long-term opioid use was defined using a validated administrative algorithm. Over a mean follow-up of 4.5 years, 6.9% of patients with gout received long-term opioids compared with 3.8% of controls.
After adjustment for demographic and clinical variables, gout remained independently associated with long-term opioid receipt (adjusted hazard ratio 1.30). The authors concluded that “patients with gout are more likely to receive long-term opioids than counterparts without gout, independent of other factors.”
Within the gout cohort, several characteristics were associated with increased likelihood of prolonged opioid exposure. These included younger age, female sex, non-Hispanic Black race and ethnicity, rural residence, underweight or obesity, current or former smoking, greater comorbidity burden, urate-lowering therapy use, and rheumatology consultation. The association with urate-lowering therapy and specialty care suggests that patients with more severe or complex disease may be particularly vulnerable.
The authors noted that this risk “is greater in underrepresented gout populations, those with greater comorbidity, patients requiring rheumatology consultations, and individuals prescribed urate-lowering treatments.”
Reference
Helget LN, England BR, Roul P, et al. Long-term opioids in gout: a matched cohort study from the Veterans Health Administration. Arthritis Care Res (Hoboken). Published online August 4, 2025. doi:10.1002/acr.25622
