Presentation Authors: Leonid Aksenov*, Ashley Johnston, Brenton Winship, Russell Terry, Michael Lipkin, Jonathan Routh, Glenn Preminger, Charles Scales Jr., Durham, NC
Introduction: A critical barrier to addressing the ongoing opioid crisis in the US is understanding current prescribing patterns for acute pain, such as pain associated with symptomatic urolithiasis. For symptomatic urolithiasis, non-opioids, such as nonsteroidal anti-inflammatory drugs, are equally efficacious, longer lasting, and safer than opioids. Given this context, our objective is to describe analgesic prescribing patterns and trends for symptomatic urolithiasis in US emergency departments (EDs).
Methods: We conducted a cross-sectional analysis of visits for urolithiasis in the 2006-2014 National Hospital Ambulatory Medical Care Survey-Emergency Department. Established diagnostic codes were used to identify all adult (â‰¥18 years) visits for urolithiasis. The primary outcome was pain medication type administered, which was identified using Multum Lexicon third-level drug categories. Covariates included medication administration setting, pain on admission, age, gender, and race. Pain severity was derived from the standard 10-point pain scale (mild [1-3], moderate [4-6], or severe [7-10] pain). Nationally representative estimates were analyzed using the Rao-Scott chi-square test or Z-test, as appropriate.
Results: From 2006 to 2014, there were approximately 13 million US ED visits for urolithiasis. Overall, opioid prescribing for symptomatic urolithiasis increased from 70% in 2006 to 84% in 2014 (P=0.011 for trend). Opioids were prescribed during visits at a rate of 61% and at visit discharge at a rate of 53%. Non-opioids were prescribed during visits at a rate of 52% and at visit discharge at a rate of 18%. The majority (73%) of patients with severe pain received opioids during their visit. Almost half (44%) of patients reporting mild pain received an opioid during their visit. At visit discharge, 52% of patients with mild pain were prescribed opioids and 59% of patients with severe pain were prescribed an opioid, with no statistical difference between the proportions (P=0.423). Non-white patients were less likely to receive opioids than white patients during their ED visit (54% vs. 61%, P=0.044) and at visit discharge (43% vs. 56%, P=0.019).
Conclusions: Despite the evidence that non-opioids are safer, more effective, and longer lasting than opioids, US physicians continue to liberally prescribe opioid analgesics for symptomatic urolithiasis. Our findings highlight the need for strategies to minimize opioid use for symptomatic urolithiasis and understand differences in pain management.