POS0014 TIME-TRENDS IN COCAINE AND HALLUCINOGEN USE DISORDER HOSPITALIZATIONS IN RHEUMATIC DISEASES: A NATIONAL TIME-TRENDS STUDY
Authors: J. Singh
Journal: Annals of the Rheumatic Diseases (2021)

Background: Cocaine use disorder is a frequent cause of drug use disorders in the U.S. Although hallucinogen use disorder is less common, both are potentially preventable public health issues. To our knowledge, epidemiological studies estimating burden of cocaine or hallucinogen use disorders in common Musculoskeletal diseases (MSDs) are lacking. Objectives: To assess national time-trends in cocaine use and hallucinogen use disorders in people with MSDs Methods: This study used the U.S. National Inpatient Sample (NIS), a de-identified national all-payer inpatient health care database ( https://www.hcup-us.ahrq.gov/nisoverview.jsp ) from 1998-2014. The NIS is a 20% stratified sample of hospital discharges in the U.S. It is commonly used to derive national estimates of hospitalization and outcomes. Cocaine or hallucinogen use disorder hospitalization was defined in a validated approach as the presence of the following International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes: cocaine use disorder, 304.2x, or 305.6x; and hallucinogen use disorder, 304.5x or 305.3x; hospitalizations for drug use in remission, drug counseling, rehabilitation or detoxification were excluded, as in previous studies. MSDs were identified based on the respective ICD-9 codes, a validated approach (5-9), in non-primary position: Gout: 274.xx; rheumatoid arthritis (RA): 714.xx; Fibromyalgia: 729.1; osteoarthritis (OA): 715.xx; or low back pain (LBP): 724. Results: In 1998-2000, the highest frequency of cocaine use hospitalizations was in people with LBP: LBP (n=5,914), followed by OA (n=4,931), gout (n=2,093), RA (n=2,026), and fibromyalgia (n=1,620). In 2013-2014, the order changed slightly with OA (n=22,185), followed by LBP (n=16,810), gout (n=10,570), RA (n=8,975), and fibromyalgia (n=5,680). Respective rates per 1 million U.S. NIS hospitalizations in 2013-2014 and the relative increase from 1998-2000 to 2013-2014 were: Gout, 10.2 (increase, 4.1-fold); OA, 21.4 (3.5-fold); fibromyalgia, 5.48 (2.5-fold); RA, 8.66 (3.4-fold); and LBP, 16.22 (1.8-fold; Figure 1). In 1998-2000, hallucinogen use disorder hospitalizations were as follows: LBP (n=176), followed by OA (n=63), RA (n=42), fibromyalgia (n=41) and gout (n&lt;10; cells with frequency of 10 of fewer are reported as &lt;10 per NIS guidance). In 2013-2014, the frequency order was the similar, with the highest numbers for LBP (n=525) followed by OA (n=400), RA (n=395), gout (n=135) and fibromyalgia (n=125). Respective rates per 1 million US NIS hospitalizations in 2013-2014 and the relative increase from 1998-2000 to 2013-2014 were: Gout, 0.13 (increase, 25-fold); OA, 0.39 (5.5-fold); fibromyalgia, 0.12 (2-fold); RA, 0.38 (8.5-fold); and LBP, 0.51 (2-fold; Figure 1). Conclusion: This study confirmed an increasing rate of both, cocaine use and hallucinogen use disorder hospitalizations in people with 5 MSDs over a 17-year period from 1998-2014 in the U.S. Figure 1. Time-trends in the rates of hospitalization with cocaine use and hallucinogen use disorder (A), non-home discharge (B), and in-hospital mortality (C) per 100,000 NIS hospitalization claims. The x-axis shows rate per 100,000 NIS hospitalization claims and the y-axis the study periods Acknowledgements: I thank John D. Cleveland, MS of the University of Alabama at Birmingham for performing data analyses according to the protocol. Disclosure of Interests: Jasvinder Singh Shareholder of: JAS owns stock options in TPT Global Tech, Vaxart pharmaceuticals and Charlotte’s Web Holdings, Inc. JAS previously owned stock options in Amarin, Viking and Moderna pharmaceuticals., Consultant of: JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio Health, Medscape, WebMD, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, the National Institutes of Health and the American College of Rheumatology. JAS is on the speaker’s bureau of Simply Speaking. JAS is a member of the executive of Outcomes Measures in Rheumatology (OMERACT), an organization that develops outcome measures in rheumatology and receives arms-length funding from 12 companies.