Increased risk of new persistent opioid use in pediatric and young adult patients with kidney stones

Abstract

Introduction: Adolescents and young adults are a vulnerable patient population for development of substance use disorder. However, the long-term impact of opioid prescribing in young adult patients with renal colic is not known. Our objective was to describe rates of opioid prescription and identify risk factors for persistent opioid use in patients age 25 years or younger with renal colic from kidney stones. Methods: Using previously validated linked administrative databases, we performed a population-based retrospective cohort study of opioid-naïve patients age 25 years or younger with renal colic between July 1, 2013 and September 30, 2017 in Ontario. All family practitioner, urgent care, and specialist visits in the province were captured. Our primary outcome was persistent opioid use defined as filling a prescription for an opioid between 91 and 180 days after initial visit. Ontario utilizes a narcotic monitoring system, which captures all opioids dispensed in the province. Results: Of the 6962 patients identified, 56% were prescribed an opioid at presentation and 34% of those were dispensed more than 200 oral morphine equivalents. There was persistent opioid use in 313 (8.1%) patients who filled an initial opioid prescription. In adjusted analysis, those prescribed an opioid initially had a significantly higher risk of persistent opioid use (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.50–2.29) and opioid overdose (OR 3.45, 1.08- 11.04). There was a dose-dependent increase in risk of persistent opioid use with escalating initial opioid dose. History of mental illness (OR 1.32, 1.02- 1.71), and need for surgery (OR 1.71, 1.24- 2.34) were also associated with persistent opioid use. Conclusions: Among patients with kidney stones age 25 years or younger, filling an opioid prescription after presentation is associated with an increased risk of persistent opioid use 3-6 months later and a higher risk of serious long-term complications such as opioid overdose.