Presentation Authors: Matthew Clements*, C William Pike, Jacqueline Zillioux, David Rapp, Charlottesville, VA
Introduction: The opioid epidemic has been the recent focus of significant national initiatives to reduce the misuse of opioids and related addiction. Interstitial cystitis (IC) is a chronic pain state at risk for frequent narcotics use. Accordingly, we sought to assess narcotic prescription use in patients with IC through analysis of patient claims data.
Methods: Data were accessed from the Virginia All Payers Claims Database (VAPCD), a dataset that includes medical and pharmacy claims from state residents insured through Medicare, Medicaid, and private commercial insurers. We identified female patients with diagnosis of IC from 2011-2017 using International Classification of Disease (ICD) codes 595.1 (ICD9) or N30.10 (ICD10). A patient identifier was used to link diagnosis claims with outpatient prescription claims for opioids by using generic product identifiers. We then analyzed opioid prescriptions within 30 days of a claim with IC diagnosis.
Results: A total of 6,989 patients with an IC diagnosis were identified and were associated with 31,685 claims. Accordingly, the median number of IC claims per patients was 7 (IQR 3,21). Mean patient age was 48.6 (95% CI 48.5, 48.7). 27.8% of patients had at least 1 opioid prescription, with a median of 2 prescriptions (IQR 1, 4). In those patients receiving opioids. 186 (9.6%) patients had more than 10 prescriptions for opioids, with a max of 129. The most common prescriptions were hydrocodone (n=2579, 31.5%), oxycodone (n=1889, 23.1%), and tramadol (n=1139, 13.9%). In addition, prescriptions for methadone (n=101, 1.2%) and buprenorphine (n=40, 0.5%) were associated with IC diagnosis. Opioid prescriptions per month are shown in Figure 1, demonstrating a decline in opioid prescriptions per month for IC. However, the rate of narcotic prescriptions per IC diagnosis remained stable.
Conclusions: A significant number of patients with IC diagnosis are treated with opioids, with a percentage receiving a large number of opioid prescriptions. While the overall number of opioid prescriptions associated with IC appears to be declining, the prescription rate per IC diagnosis has not declined over the study years. As part of the national initiative to reduce narcotics use, our data suggest that IC treatment strategies should be examined.