Contributing to a Crisis? Defining National Patterns in Opioid Prescribing after Outpatient Vasectomy (#PD58-05): Opioid misuse and addiction has been reported as a public health crisis in recent years, and some postulate that post-operative prescribing patterns could be a contributing factor. According to researchers from Ann Arbor, MI, surgeons may be positioned to help decrease the risk of opioid misuse after surgery by minimizing the availability of unnecessary surplus medication. Using data from the Clinformatics Data Mart Database, researchers identified more 25,102 men who underwent vasectomy from 2012-2014 and assessed the type and quantity of opioids prescribed. While the study showed that less than half of the patients filled their opioid prescription after the procedure, there was a 13-fold difference in the quantity of opioid painkillers prescribed (range of six to 78 5 mg hydrocodone tablets per prescription). Given that non-opioid pain management strategies may be acceptable for the majority of men after vasectomy; opioid prescribing strategies may be warranted.
Antimuscarinic Use in the Elderly: A Poisoned Apple? (# MP69-01): Antimuscarinic medications are a common first-line treatment for overactive bladder (OAB), the symptoms of which are urinary urgency, frequency, nocturia (bed-wetting), and urinary incontinence (UI). Some antimuscarinic medications have harmful effects, including cognitive decline, which has raised concern about the use of these drugs in patients over the age of 65. Researchers in Detroit and Boston examined the use of antimuscarinics in this population using data from the National Ambulatory Medical Care Survey (NAMCS). They reviewed records for patients with newly given or renewed prescriptions with any of six antimuscarinics, including oxybutynin, a generic, less-expensive medication that has been shown to be the least suitable of the six antimuscarinics reviewed in this study. Data showed an “alarmingly high” rate of prescriptions for oxybutynin, a trend that could be driven by tiered Medicare formularies that require patients to trial oxybutynin before allowing access to newer, more costly, yet safer, antimuscarinics.
“These studies reveal valuable insights into post-operative pain management and adverse outcomes in geriatric treatment for OAB,” said Dr. Averch. “Increased consideration of non-opioid pain strategies and suitable alternatives to antimuscarinic use can help patients and surgeons to make more informed and safe treatment decisions.”