Moon AM, Watkins SE, Lok AS, et al. - In a real-world cohort of patients with non-alcoholic fatty liver disease (NAFLD), the prevalence and patient features related to opioid use were explored. Researchers conducted an observational study in the United States with participants at 55 academic and community sites, including patients with NAFLD characterized by pragmatic case definitions. Any documented opioid prescriptions in the year prior to enrollment characterized opioid use. A total of 3,474 adult patients with NAFLD were included in this cohort (18.2% with documented opioid use). Having cirrhosis, BMI ≥32 kg/m2, depression, and anxiety were features linked with opioid use. The greatest relative importance in predicting opioid use was seen with history of back pain, abdominal pain, BMI and depression, as seen in the boosted tree analysis. Nearly one of five patients with NAFLD used prescription opioids. Alternative therapies including low dose acetaminophen and non-pharmacologic treatments should be considered for these patients, given the safety concerns of opioids.