AUA 2019: Risk Factors for Prolonged Opiate Use in Patients with Acute Nephrolithiasis

Chicago, IL ( It is no surprise that opiate-related deaths continue to remain a dire problem within our nation. There are approximately 64,000 opiate-overdoses annually, with 2 million Americans abusing or addicted to their medications. Stone surgery is found to have a high opioid dependence or overdose rate. Dr. Brittney Cotta from the University of California, San Diego and her research team sought to determine if patients with acute nephrolithiasis were at a higher risk for opiate abuse.

For this retrospective study, 94 patients from June 2017 to June 2018 with an imaging study demonstrating a stone and acute pain as a symptom were included. Of these patients, all relevant stone data including previous procedures, treatment plans at each episode, and medications prescribed at each presentation. Opiate data from CURES 2.0 (Controlled Substance Utilization Review and Evaluation System) was also obtained for each patient.

When observing these statistics, they found that there were increased risks for patients with a large stone size, longer time to stone resolution, and previous opiate prescription at the time of presentation. A total of 63 of them filled an opiate prescription during the first presentation of their acute stone episode, while 28 patients refilled their opiate prescription prior to receiving any stone treatment.

This topic serves as a wakeup call to many practicing providers as timely treatments with non-narcotic use is extremely important to mediate our opiate health crisis. When patients present to the ED and are unable to reach a urologist before the stone condition worsens, they are at a higher risk to refill their opiate prescription. If not a timely problem, we need to focus on alternatives to narcotics, resolving the risk of prolonged opiate use. We may even choose to educate the ED community to refer them to urology earlier or prescribe a non-opiate medication.

Though there are important conclusions to be made for this study, there are still limitations as getting an appointment with a new urologist in San Diego is difficult, contributing to the timely problem. This may not be as prevalent in other regions of the nation given the high population along the east and west coast. Nonetheless, the trend away from narcotics and toward alternative medications is the next step in moving toward lower risk for opioid dependence or overdose. Alternatives need to be implemented, but we first need to stop what we’re doing now and reflect on how we could do better without the risks of opiates.
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Presented by: Brittney Cotta, MD, Urologist, UC San Diego

Written by: Sherry Lu, (Department of Urology, University of California-Irvine) at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois