A new US study has found that people living with rheumatic conditions such as rheumatoid arthritis, lupus and osteoarthritis face a measurable risk of opioid use disorder, and that most of those affected are not receiving the medications known to help them recover.

Researchers from Cambridge Health Alliance and Harvard Medical School looked at health records from more than 37,000 patients enrolled in the All of Us Research Program, a large national database. They wanted to understand who among patients with rheumatic conditions goes on to develop opioid use disorder, and how their care differs from those who do not.

What the researchers found

Of the 37,282 patients included in the analysis, 1,502, or around 4%, had a diagnosis of opioid use disorder. Those patients tended to be younger, and were more likely to hold Medicaid insurance, to live with additional psychiatric and medical conditions, and to rely more heavily on emergency and acute hospital care than patients without opioid use disorder.

The gap in prior opioid exposure was striking. Among patients who went on to develop opioid use disorder, 75.7% had previously been prescribed opioids, compared with 45.8% of those who did not. Patients with opioid use disorder were also more likely to have been given glucocorticoids, commonly known as steroids, but less likely to have received disease-modifying antirheumatic drugs, or DMARDs, the medications typically used to manage the underlying joint and autoimmune disease itself.

Perhaps the most concerning figure in the study relates to treatment. Only 14.5% of patients with a rheumatic condition and opioid use disorder went on to receive medications for opioid use disorder, such as methadone, buprenorphine or naltrexone. That is well below the roughly 25% treatment uptake reported nationally among the wider population with opioid use disorder.

Why this matters

Rheumatic conditions often cause chronic, persistent pain, and opioids have long been used as one tool to manage it. What this study suggests is that the pattern of opioid prescribing among these patients may be linked to a higher chance of dependence developing further down the line, particularly among those who are not being treated with DMARDs for their underlying condition.

The authors were careful to note that their analysis is descriptive, meaning it cannot prove what is actually driving these patterns. It cannot say, for instance, whether some patients were prescribed opioids because their rheumatic disease was not well controlled, or whether prescribing habits themselves varied depending on a patient’s circumstances, such as their insurance type or access to specialist rheumatology care.

Lead author Jacob Riegler and colleagues wrote that future research needs to dig into the risk factors behind opioid use disorder in this population, including prescribing patterns and illicit opioid use, as well as the reasons behind the lower rates of DMARD and glucocorticoid prescribing seen in the study. They also called for closer study of why so few patients go on to start, and stay on, treatment for opioid dependence once it develops.

The bigger picture

Opioid misuse remains one of the most persistent public health challenges, and chronic pain conditions are frequently part of that story. This study adds to a growing body of evidence showing that people managing long-term illness, not just those with a history of substance use, can be vulnerable to opioid dependence when pain management and disease treatment are not properly balanced.

The low rate of treatment uptake found in this study is a reminder that recognising opioid use disorder is only the first step. Making sure people actually receive support and treatment once a problem is identified is just as important, and right now, for patients with rheumatic conditions, that support appears to be reaching far fewer people than it should.

The study was published online on 13 July 2026 in Arthritis Care & Research and was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Source: dbrecoveryresources