Presentation Authors: Jonathan Shoag, Neal Patel, Lina Posada*, New York, NY, Joshua Halpern, Chicago, IL, Talia Stark, Philadelphia, PA, Jim Hu, New York, NY, Brian Eisner, Boston, MA
Introduction: The rise in opioid related deaths and addiction has been linked to physician prescribing. Opioids are commonly prescribed to patients with renal colic due to nephrolithiasis. The aim of this study is to describe the relationship between nephrolithiasis and opioid use in the United States.
Methods: We performed an analysis of data from the National Health and Nutrition Examination Survey (NHANES), a periodic survey conducted by the Centers for Disease Control and Prevention, to monitor trends in the civilian population of the United States. Questions about a history of nephrolithiasis and medication use in the last 30 days were included in the Continuous NHANES surveys from 2007 to 2014. A total of 23,482 subjects over the age of twenty were surveyed, 382 (1.2%) were missing data for one or more variables and were excluded from the analysis.Multivariable logistic regression was used to evaluate the independent association between medical conditions and narcotic use. Covariates were included in the model a-priori, independent of univariate p-values, for the association between medical conditions and narcotic use. All p-values are two-sided with statistical significance evaluated at the 0.05 alpha level.
Results: We found that among 23,100 subjects, current opioid use was significantly greater among those who reported a history of kidney stones at 10.9% (95% confidence interval (CI) 9.1% to 12.9%), as compared to 6.1% (95% CI 5.4% to 6.8%) of those who did not report a history of stones. The prevalence of opioid use increased with the number of kidney stones passed, reaching 13.7% (95% CI 11.1% to 16.9%) in subjects who had passed two or more stones, p < 0.001. On multivariable logistic regression analysis adjusting for age, gender, smoking status, number of healthcare visits in the past year, and comorbid conditions, nephrolithiasis was independently associated with opioid-based medication use, OR 1.27 (95% CI 1.07 to 1.49), p=0.006.
Conclusions: The association between a history of kidney stones and narcotic use suggests that nephrolithiasis may be a risk factor for long-term opioid use, and that altering pain management strategies in this population may be beneficial.