Nearly 1 in 16 opioid-naïve patients develop new persistent opioid use following ureteroscopy (URS) for upper tract stones, a study found.
Investigators led by John M. Hollingsworth, MD, MS, of the University of Michigan in Ann Arbor, used commercial claims data to identify 27,740 patients who underwent outpatient URS. Of these, 14,196 (51.2%) were opioid-naïve and 9230 (33.3%) and 4314 (15.6%) were intermittent and chronic users of opioids, respectively. New persistent opioid use—defined as continued use of opioids 91 to 180 days after URS among patients who were previously opioid naïve—developed in 878 (6.2%) opioid-naïve patients, Dr Hollingsworth’s team reported in Urology.
Patients continued filling prescriptions with doses equivalent to nearly 1 tablet per day of 5-mg hydrocodone even 6 months after URS, “a daily rate which is higher than that of intermittent narcotic users,” according to Dr Hollingsworth and his collaborators.
Moreover, the investigators found that the amount of opioid prescribed at the time of surgery was strongly associated with development of new persistent opioid use. Patients in the highest tercile of opioids prescribed at the time of URS had significant 69% higher odds of new persistent opioid use compared with those in the lowest tercile after adjusting for measured sociodemographic and clinical differences.
“Given the growing opioid epidemic in the U.S. and large volume of ureteroscopy procedures performed each year, our findings are timely,” the authors concluded. “In light of them, urologists should re-evaluate their post-URS opioid prescribing patterns.”
With regard to study limitations, the investigators pointed out that although they had data on the number of opioid pills prescribed, they did not know the precise quantity taken. As the study looked at insurance claims, the investigators could not identify opioid prescriptions that were paid for out-of-pocket and prescriptions that were never filled. In addition, Dr Hollingsworth’s team noted that their study population was identified from a large cohort of commercially-insured working-age adults and their dependents, so findings may not be generalizable to uninsured or underinsured patients and those aged 65 years and older.
Tam CA, Dauw CA, Ghani KR, et al. New persistent opioid use after outpatient ureteroscopy for upper tract stone treatment [published online September 16, 2019]. Urology.