Presentation Authors: Annah Vollstedt*, Lebanon, NH, William Meeks, Aient Ngon, Linthicum , MD, Vernon Pais, Lebanon, NH
Introduction: With the spotlight on the nation&[prime]s opioid crisis, urologists should be cognizant of our patients&[prime] use of opioid analgesics. Prescription opioid exposure has been associated with subsequent opioid abuse and dependence. Stone formers may be particularly susceptible to prescription opioid exposure as the marked severity and acuity of renal colic associated with stones often prompts opioid analgesia. However, the percent of stone patients newly exposed to opioids remains poorly defined. We sought to provide an account of new opioid use among new stone formers.
Methods: The Medical Expenditure Panel Survey (MEPS), a nationally-representative survey, collects longitudinal information regarding prescription drug use, medical diagnoses and medical encounters over the course of 2 years. Data for each 6-month panel are collected in 5 rounds of interviews. Adult participants who were opioid-naive and stone-naive at survey inception and then subsequently reported a new kidney stone occurrence were included in the analysis. The sample weights and strata derived by MEPS were used to allow the surveyed cohort to represent civilian, non-institutionalized US population. Patients characteristics were then assessed with multivariate logistic regression for association with new opioid use.
Results: The weighted data revealed over 10 million Americans were both kidney stone and opioid naÃ¯ve at survey inception and then subsequently developed a kidney stone over the 2-year surveyed period. Of these, 42% received an opioid prescription. Smoking and increased number of emergency department (ED) visits for kidney stone were associated with opioid prescriptions (p=0.003 and 0.002, respectively). By U.S. region, the south was most strongly associated with the use of opioid prescriptions. Age, sex, race, BMI, education, diabetes, income, insurance status, depression/anxiety were not associated with opioid prescription in stone formers. Adjusting for region, smoking, and number of ED visits, new stone formers were significantly more likely to receive prescription opioids than non-stone formers (OR 6.5, 95% CI 4.48-9.08).
Conclusions: Over 40% of stone formers will receive a new opioid prescription. Those new stone formers who are smokers are more likely to have an opioid prescription, which is consistent with previous studies. The association of opioid prescriptions and the increased number of ED visits for kidney stones suggests timely intervention to reduce repeat ER visits may reduce opioid exposure. Further assessment of specialty-related prescribing habits may also be warranted.
Source of Funding: AUA 2018 Data Grant