Deepan S. Dalal
Despite available treatments, more than 28% of patients with gout who are discharged from the ED receive opioids for pain, according to data published in Arthritis Care & Research.
“Gout is the most common form of inflammatory arthritis and a frequent cause of visit to the ED,” Deepan S. Dalal, MD, MPH, of the Brown University Warren Alpert School of Medicine, told Healio Rheumatology. “Despite effective therapy, anecdotal evidence suggests that opioids are frequently used for treatment of acute gout, which can potentially lead to long term opioid use.”
To analyze the frequency, dose and duration of opioid use, as well as the factors linked to opioid use, among patients with gout who are discharged from the ED, Dalal and colleagues conducted a retrospective cohort study of electronic health records from the Lifespan Healthcare System. According to the researchers, Lifespan is the largest health care provider in Rhode Island, with records of 2.2 million patients throughout the state. The researchers identified adult patients with gout using ICD9 or ICD10 diagnostic codes, from March 2015 to September 2017.
More than 28% of patients with gout who are discharged from the ED receive opioids for pain, according to data.
A total of 456 patients with a primary diagnosis of gout during that time were included in the study. If records indicated a patient was seen multiple times, only the first visit was analyzed. The researchers examined all prescriptions given in the electronic medical record, and used multivariable logistic regression to determine the factors associated with an increased likelihood of receiving opioids at discharge.
According to the researchers, 129 patients, or 28.3% of those analyzed in the study, received a prescription for opioids at discharge. Approximately 80% of those prescriptions were new. In addition, the average prescription dose was 37.9 mg of morphine equivalent, for a median duration of 8 days. Patients with polyarticular gout attacks, diabetes or previous opioid prescriptions were more likely to leave the ED with opioids, the researchers wrote.
“In our study, we noted that an alarming 28% of patients getting discharged from a facility are given prescription opioids, a quarter of which are longer than 14 days duration — longer that a typical gout attack,” Dalal said. “Further, 80% of these prescriptions are given to individuals not on prescription opioids at presentation. The study essentially renders an opportunity to reduce prescription opioids further curb the opioid epidemic.” – by Jason Laday
Disclosure : Dalal reports employment with Lifespan Healthcare System.