High Opioid Prescription Rates Seen in Emergency Department-Treated Gout

Acute gout can be very painful, causing patients to seek treatment in the emergency department. A retrospective study of pain interventions for gout in Rhode  Island found that nearly 30% of patients received prescriptions for opioid medications over 30 months. Of these prescriptions, over 80% were for patients who had never been exposed to opioids prior to the visit.¹

“It should be clear by now that opioids have absolutely no role whatsoever in altering the course of gout,” says Deepan S. Dalal, MD, MPH, an assistant professor of medicine in the Department of Rheumatology, Brown University, Warren Alpert School of  Medicine, East Providence, R.I. “Opioids are analgesics and can reduce the pain associated with the disease. But we have other conventional medications, such as colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, that can bring down pain and inflammation within the first 24 hours.”

Study

Using the electronic health records of Lifespan, Rhode Island’s largest healthcare provider, the researchers included all patients older than 18 years who had  been released from the emergency department or an inpatient facility with a diagnosis of gout between March 30, 2015, and Sept. 30, 2017. Patients with gout  as a secondary, tertiary or subsequent-to-the-emergency department visit diagnosis were excluded, as were those with other crystal-induced and inflammatory arthritis.

The first encounters at the emergency department for 456 patients were included. The average patient was 58.7 years (±16.4 years) old, and 79% were  men. Of these, 129 patients (28.3%) were discharged with a prescription for opioids.

Each patient’s medical record was reviewed to ensure the visit was  for gout. If not, they were excluded. The first encounter during the study period was the only one included if multiple visits were indicated.

Opioid Prescription  Rates

“We were not really surprised to find that nearly 30% of patients were prescribed some type of opioid,” says Dr. Dalal. “What was remarkable was the finding that 80% had not received opioids for any reason in the past. They were completely opioid naive.”

Another finding of interest was  the length of the prescription. Roughly one patient in four received a prescription for 14 days’ worth of medications—a period much longer than a typical gout attack lasts.

The study also examined factors associated with an increased opioid prescription rate in the emergency department. Those receiving opioids had a higher prevalence of diabetes, polyarticular gout and opioid use at admission. “One of the strongest predictors of opioid use in gout patients was diabetes as a comorbidity,” says Dr. Dalal. “This wasn’t a survey of attitudes, but we theorize that there are a couple of things going on.”