Incidence and Predictors of Repeated and Prolonged Opioid Prescriptions After Kidney Stone Event
Annah J. Vollstedt, MD1, WIlliam Meeks, MA2, Aeint Ngon, MA2, Brian Sites, MD, MS1, Vernon Pais, Jr., MD, MS1
1Dartmouth Hitchcock Medical Center, Lebanon, NH, 2American Urological Association, Department of Data Management and Statistical Analysis, Linthicum, MD
Background Opioid analgesics are often employed in the management of acute renal colic. However, prescription (Rx) opioids are recognized as the leading initial exposure for those suffering from chronic opioid use and abuse. We sought to determine the percent and characteristics of stone formers who were refilled an opioid prescription within 6 months of their incident stone event, as well as those who continued to have an opioid Rx one year after. Methods We assessed the cohort of US adults participating in the Medical Expenditure Panel Survey between 2005 and 2015. This nationally representative survey collects longitudinal data regarding medical diagnoses, encounters, and prescription drug use. Each participant is surveyed every 6 months over the course of 2 years. Those with an ICD-9 code for an incident kidney stone who also received an opioid Rx during the index 6-month period were included in the analysis. Patient characteristics were assessed for association with repeat opioid prescriptions within the same 6 months and for association with opioid use greater than 1 year after the incident stone. Results Of those stone formers receiving an opioid Rx, 49.8% received additional opioid prescriptions within the same 6-month panel. Diabetes, lower income government insurance status, anxiety depression and alcohol-related disorders were significantly associated with additional opioid prescriptions within 6 months; Asian/Native Hawaiian/Pacific Islander survey participants were less likely to have additional opioids on univariate and multivariate analysis (p<0.05). Of those receiving an opioid Rx, 21.8 % were still filling an opioid Rx the following year. On multivariate analysis, both anxiety and depression each increased the odds of prolonged opioid use by >50% (OR 1.5 and 1.6, respectively, p<0.001). Conclusions Our nationally-representative, longitudinal study reveals that of those stone formers receiving an opioid Rx, 50% received them repeatedly. Furthermore, over 20% have an opioid Rx one year later. Finally, we identified those stone formers who may be more susceptible to both repeated and prolonged opioid use. This information may be helpful when counseling our patients on both medical and peri-operative pain management of acute renal colic.
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