Prescription Opioid Use Among Patients With Acute Gout Discharged From the Emergency Department

Dalal, Deepan; Mbuyi, Nadine; Shah, Isha; Reinert, Steven E.; Hilliard, Ross

doi:10.1002/acr.23928

Cited by 15 publications

(15 citation statements)

References 32 publications

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“…With the current opioid epidemic, it is important to consider that uncontrolled gout may also serve as a gateway to opioid use. A recent study using electronic health records from the state of Rhode Island found that nearly 30% of patients who were treated in the emergency department with a primary diagnosis of gout were prescribed opioid therapy at discharge (5). This opioid prescription rate is nearly twice what is observed in emergency departments across all medical conditions (49).…”

Section: Discussionmentioning

confidence: 99%

“…These figures have grown with 2012 estimates using the same data source demonstrating >200,000 gout‐related emergency department visits, with encounter‐related charges exceeding $280 million (4). This increase in gout‐related emergency department visits is particularly relevant, as almost one‐third of patients with gout seen in the emergency department receive an opioid prescription at discharge (5), suggesting that gout may serve as a gateway to chronic opiate use even though highly effective gout therapies are available. In addition to direct health care costs and costs posed by potentially inappropriate care, gout is also independently associated with increased work absenteeism and losses in work productivity.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, Prevalence, and Burden of Gout in the Veterans Health Administration

Helget

England

Roul

et al. 2021

Arthritis Care & Research

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Objective To determine the prevalence, incidence, and burden of gout in the Veterans Health Administration (VHA) from 2005 to 2014. Methods We used national VHA data from January 1999 to December 2014 to determine the annual incidence and prevalence of gout in the VHA. Gout burden to the VHA was determined by the proportion of patients with an encounter related to gout. Rates of urate‐lowering therapy (ULT) and opiate use were determined annually. Characteristics of those with and without gout were compared using 2014 data. Results From 2005 to 2014, gout prevalence in the VHA increased from 4.2% to 5.8%, while disease incidence ranged from 5.8 to 7.4 cases per 1,000 patient‐years. Gout prevalence was highest among men, older patients, and non‐Hispanic black patients. During 2014, 4.0% of all inpatient or outpatient encounters and 1.3% of hospitalizations were gout related. Administration of ULT remained stable over the 10‐year period, with 46% of gout patients receiving ULT in 2014. In contrast, 16.4% of prevalent gout patients were receiving a weak opioid in 2014, nearly doubling the prescription rate of weak opioids in 2005, while the use of stronger opioids did not change significantly over this period. Patients with gout had greater comorbidity and health care utilization than patients without gout. Conclusion The burden posed by gout in the VHA is considerable and increased between 2005 and 2014. While the use of ULT has remained stable, the use of opioid therapy has increased among patients with gout.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence, Prevalence, and Burden of Gout in the Veterans Health Administration

Helget

England

Roul

et al. 2021

Arthritis Care & Research

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“…Hence, there is almost no role for opioid analgesics in the management of acute gout. Yet both the studies, by Dr. Schlesinger’s group and ours, report that approximately one‐third of patients with acute gout in the ED receive opioid prescriptions at discharge (1,4). There are 3 aspects of this observation that are particularly interesting and that warrant further investigations.…”

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confidence: 86%

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Dalal

Mbuyi

2020

Arthritis Care & Research

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“…We would like to thank the editors for providing us an opportunity to further the discussion regarding opioid use for management of acute gout and thank Dr. Schlesinger and colleagues for highlighting yet another study describing the burden of opioid prescription for gout management (1). As appropriately pointed out, opioids do not reduce the inflammation of an acute gout attack, and conventional antiinflammatories like colchicine, nonsteroidal antiinflammatory drugs, and steroids can substantially reduce pain within the first 24 hours of administration (2,3).…”

Section: Replymentioning

confidence: 99%

Treatment of Acute Gout Flares in the Emergency Department: Comment on the Article by Dalal et al

Schlesinger

Brunetti

2020

Arthritis Care & Research

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Treatment of acute gout flares in the emergency department: comment on the article by Dalal et al To the Editor: Acute gout flares account for a substantial number of visits to the emergency department (ED), and treatment of the acute gout flare in the ED was the subject of an interesting article by Dalal et al (1), recently published in Arthritis Care & Research. The authors reported that 28.3% of the 456 patients included in the study received an opioid at discharge. Furthermore, 80% of the opioid prescriptions were new, indicating that a large proportion of patients without previous exposure to an opioid were now exposed. We reported on the diagnosis and treatment of acute gout flares in a large series of 541 consecutive ED visits over a 7-year period (2). In our study 35% of patients were given an opiate (oxycodone/acetaminophen) during the ED visit, and 52% were given a prescription for an opiate. Opiates comprised over half of the medications given during the ED visit and as prescriptions (1,2); however, use of analgesia alone does not treat gouty inflammation. Health services research has shown that the number of ED visits due to disease exacerbations may be indicative of suboptimal chronic disease management and poor treatment adherence (3). Both the study by Dalal et al and our own study indicate that the treatment of gout flares in the ED warrants closer attention. Studies are urgently needed to assess the use of opiates in the treatment of gout flares. Previous studies suggest that opiate exposure in the ED precedes addiction (4,5), and the use of opioids for acute pain is associated with an increased risk for long-term use (6). In the current landscape of opioid abuse and addiction, prescription of these agents should be prudent. The importance of antiinflammatory drug treatment during acute flares should be emphasized, as well as the treatment of gout as a longitudinal disease and not just an acute flare. The clinical importance of this study is that it will increase discussion about the treatment of acute gout flares in the ED and beyond. Thus, the study has the potential of improving the treatment of gout flares and possibly leading to the development of evidence-based guidelines tailored to the ED.

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Prescription Opioid Use Among Patients With Acute Gout Discharged From the Emergency Department

Cited by 15 publications

References 32 publications

Incidence, Prevalence, and Burden of Gout in the Veterans Health Administration

Incidence, Prevalence, and Burden of Gout in the Veterans Health Administration

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Treatment of Acute Gout Flares in the Emergency Department: Comment on the Article by Dalal et al

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