Recent trends in the prescription of opioids in the emergency department in patients with urolithiasis.
Document Type
Article
Publication Date
3-13-2023
Publication Title
International Urology and Nephrology
Keywords
Analgesics, Opioids, Pain, Renal colic, Urolithiasis
ISSN
1573-2584
Volume
55
Issue/No.
5
First Page
1109
Last Page
1116
Abstract
PURPOSE: Pain management is central in the treatment of urolithiasis. We aimed to estimate the impact of the 2017 Department of Health and Human Services declaration of an opioid crisis on prescribing patterns of opioids and NSAIDs in emergency department visits for urolithiasis.
METHODS: The National Health Ambulatory Medical Care Survey (NHAMCS) was queried for emergency department visits of adults with a diagnosis of urolithiasis. The association between urolithiasis and narcotic and NSAIDs prescription patterns was evaluated and compared at pre-declaration (2014-2016) to post-declaration (2017-2018) periods.
RESULTS: Opioids were prescribed in about 211 million (41.1%) out of 513 million emergency department visits, over a 5-year period. Diagnosis of urolithiasis accounted for 1.9% of the visits (6.0 million). The use of opioids was higher in urolithiasis (82.7%) compared to non-urolithiasis diagnosis (40.3%), as well as the use of multiple opioids per visit (p < 0.01 for all). There was an overall decrease in opioid prescriptions in the post-declaration period, - 4.3% for urolithiasis (p = 0.254) and - 5.6% for non-urolithiasis visits (p < 0.05). A decrease in the use of hydromorphone (- 47.5%. p < 0.001), an increase in the use of morphine (+ 59.7% p = 0.006), and an increase of 'other' opioids (+ 98.8%, p < 0.041), were observed. Opioids combined with NSAIDs comprised 72.6% of the opioid prescriptions and 62.3% of all analgesic prescriptions in visits with urolithiasis diagnosis.
CONCLUSIONS: The use of opioids when managing urolithiasis decreased 4.3% after the crisis declaration; however, statistically are not different from pre-declaration numbers. Most often, opioids were prescribed with NSAIDs in urolithiasis patients.
NSUWorks Citation
Liem, Spencer S; Demus, Timothy; Perez Rivera, Alexandra; Jivanji, Dhaval; Lee, Crystal Y; George, Kevin A; Perez, Alejandra; Cubeddu, Luigi; and Pereira, Jorge F, "Recent trends in the prescription of opioids in the emergency department in patients with urolithiasis." (2023). HPD Articles. 361.
https://nsuworks.nova.edu/hpd_facarticles/361
DOI
10.1007/s11255-023-03545-w
Copyright
© 2023. The Author(s), under exclusive licence to Springer Nature B.V.
Comments
Acknowledgements The authors thank all faculty at Mount Sinai Medical Center, NOVA Southeastern, Florida International University and Thomas Jeferson University for their collaborative mentorship with this study.
Author contribution SL Project development, Data collection, Data Analysis, Manuscript Writing/Editing, TD, AP, JP, Project development, Data collection, Data Analysis, Manuscript Writing/Editing. DJ, KG, AP, LC, Data Analysis, Manuscript Writing/Editing. CL Data collection, Data Analysis, Manuscript Writing/Editing.