“Our study suggests a high use of prescription opioid in patients discharged from the ED with a diagnosis of gout, a condition that can be managed effectively with other medications,” Deepan S. Dalal, MD, of Brown University Warren Alpert School of Medicine, Providence, and colleagues write.
Steroids, non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine can reduce pain and inflammation from gout attacks, the authors note in Arthritis Care and Research, online July 3.1
“Despite the efficacy of conventional agents, empirical evidence suggests common use of opioid analgesics in gout management,” they add.
The authors looked at Lifespan Healthcare Systems data on 456 patients discharged from the ED or hospital after treatment of acute gout between 2015 and 2017. At discharge, 28.3% were prescribed an opioid, 79% had not been on opioid medications previously.
The average dose was 37.9 mg of morphine equivalent for a median eight days.
Opioid prescription type was available for 119 patients, including 81% prescribed oxycodone or combinations of oxycodone, 8% prescribed hydrocodone and 9% prescribed tramadol.
Patients prescribed opioids at discharge were more likely to have diabetes, hypertension and substance abuse, and were also more likely to be using opioids at the time of admission. Patients with polyarticular gout attacks were also more likely to receive opioids at discharge.
“In addition to regulatory changes, the burden of opioid prescription could be potentially reduced by creating prompts for providers in electronic record system to avoid prescribing opioids in opioid-naive patients OR using lower intensity and shorter duration of prescription,” Dr. Dalal and colleagues write.
“Future prospective studies assessing the reasons for prescription of opioids may provide further insight into strategies to reduce the burden of prescription opioids,” they add.
Dr. Dalal was not available for an interview by press time.
Reference
- Dalal DS, Mbuyi N, Shah I, et al. Prescription opioid use among acute gout patients discharged from the emergency department. Arthritis Care Res (Hoboken). 2019 Jul 2. [Epub ahead of print]