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Persistent opioid use among patients with urolithiasis: a population based study


Background — Urolithiasis can result in acute, short-lived pain for which opioids are often prescribed. The risk of persistent opioid use following an initial presentation for urolithiasis is unknown.

Objective — To describe rates of opioid prescription and identify risk factors for persistent opioid use among patients with urolithiasis.

Design, Setting, and Participants — This was a population-based study of all patients diagnosed with urolithiasis in Ontario between 2013 and 2017 using administrative databases.

Outcome Measurements and Statistical Analysis — The primary outcome was persistent opioid use, defined as dispensing of opioids between 91 and 180 d after presentation. Multivariable logistic regression and Cox proportional hazard models were used to identify factors associated with outcomes.

Results and Limitations — Of 101 896 previously opioid-naïve patients, 66% were prescribed opioids at diagnosis and 41% of those were dispensed more than 200 oral morphine equivalents (OMEs). For those patients prescribed opioids, 9% had continued use. In adjusted analysis, the number of healthcare visits and having a stone intervention were associated with a higher risk of persistent opioid use (p < 0.0001). Total OME dispensed at presentation was highly associated with persistent use: for >300 OME the odds ratio (OR) was 1.59 (95% confidence interval [CI] 1.41–1.79). Among those who had an intervention, the number and type of procedure were also associated with persistent use: the OR for shockwave lithotripsy compared to ureteroscopy was 1.65 (95% CI 1.42–1.92). This study is limited by the accuracy of the diagnostic and procedural administrative codes available.

Conclusions — The majority of urolithiasis patients were prescribed opioids and 9% of previously opioid-naïve patients exhibited persistent opioid use 91–180 d after their initial urolithiasis visit.

Patient Summary — In this study we found that 9% of patients prescribed opioids at presentation for kidney stones filled an additional prescription 3–6 mo later. Risk factors for this continued use included a higher dose of opioids prescribed in the initial period and the type of kidney stone surgery.



Hosier GW, McGregor T, Beiko D, Jaeger M, Booth C, Whitehead M, Siemens DR. Eur Urol Focus. 2020; 6(4):745-51. Epub 2019 Sep 9.

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