Gout: are opioids being overprescribed in the emergency department?

  • Dalal DS & al.
  • Arthritis Care Res (Hoboken)
  • 2 Jul 2019

  • International Clinical Digest
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Takeaway

  • Nearly 30% of patients seen in the ED for acute gout received an opioid prescription, even though other treatments are available.
  • More than one-quarter of those received a 14-day prescription, which is longer than the typical gout attack.

Why this matters

  • Prior research suggests that NSAIDs and steroids reduce pain and disability associated with gout within the first 6-18 hours of treatment.

Study design

  • Study of 456 patients (age, ≥18 years) who visited emergency department (ED) with acute gout during 2015-2017.
  • Outcome: Frequency, dose, and duration of opioids prescribed at discharge.
  • Funding: No external funding.

Key results

  • 28.3% of the patients received opioid prescription at discharge.
  • Average daily opioid dose was 37.9 mg of morphine equivalents.
  • 81% of the patients used oxycodone or oxycodone combinations.
  • Median duration of the opioid prescription was 8 (interquartile range, 5-14) days.
  • More than one-quarter of these patients received 14-day prescriptions.
  • Factors associated with ≥2-fold higher risk of opioid prescription at discharge were:
    • Polyarticular gout attack (aOR, 2.02; 95% Cl, 1.05-3.90);
    • Diabetes (aOR, 2.04; 95% Cl, 1.15-3.60).

Limitations

  • Retrospective study design.

Coauthored with Antara Ghosh, PhD