Presentation Authors: Annah Vollstedt*, Lebanon, NH, Aient Ngon, William Meeks, Linthicum , MD, Vernon Pais, Brian Sites, Lebanon, NH
Introduction: 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 describe the cohort of stone formers who, after an initial opioid Rx, subsequently received repeated opioid prescriptions. Additionally, we sought to determine the frequency of prolonged opioid use greater than 1 year after the index stone diagnosis and assess predictors for this prolonged opioid use.
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. The sample weights and strata derived by MEPS were used to allow the surveyed cohort to represent civilian, non-institutionalized US population. Those with an ICD-9 code for kidney stone occurrence and received an opioid Rx during the index 6-month period were included in the analysis. Patients characteristics were assessed for association with repeat opioid prescriptions within 6 months and opioid use for greater than 1 year.
Results: Of those stone formers receiving an opioid Rx, 50.1% 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 likely less to have additional opioids on univariate and multivariate analysis (all p < 0.05). Of those receiving an opioid Rx, 21.8 % were still filling opioid prescriptions 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 study reveals that of those stone formers receiving an opioid, 50% received them repeatedly. Furthermore, over 20% still have an opioid Rx one year later. Additionally, we identify 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.
Source of Funding: 2018 AUA Data Grant