More than a quarter of patients with acute gout received a prescription for opioids at discharge from the emergency department, according to study results published in Arthritis Care & Research.

Previous studies have reported that, although steroids, nonsteroidal anti-inflammatory drugs, and colchicine are effective for reducing the inflammation and pain associated with acute gout, opioid analgesics are commonly used in these cases. In light of the ongoing opioid epidemic, the goal of the current study was to assess the burden of prescription opioid use in patients discharged from the emergency department with acute gout.

The researchers used the electronic health records system of Lifespan, the largest provider of health care in the state of Rhode Island, providing care to more than 2.2 million patients, to identify patients discharged with an acute gout event. They included adult patients discharged between March 30, 2015, and September 30, 2017. Only the first visit to the emergency department was included in the analysis.

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A total of 456 patients (mean age, 58.7±16.4 years; 79% men) were included in this retrospective study. Of these, 129 patients (28.3%) received an opioid prescription at discharge, including 102 patients (79%) who were not using these medications at the time of presentation to the emergency department. The opioids most commonly prescribed to patients discharged with acute gout were oxycodone or oxycodone combinations (81%). The median duration of opioid prescription was 8 days and the average daily dose was 37.9±17.2 morphine milligram equivalents.

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Patients prescribed vs not prescribed opioids at discharge were younger. Most were men and had hypertension, substance abuse, and opioid use at admission. The presence of diabetes (adjusted odds ratio, 2.04; 95% CI, 1.15-3.60) and polyarticular gout attack (adjusted odds ratio, 2.02; 95% CI, 1.05-3.90) were associated with an increased risk for being prescribed opioid medications at discharge.  

Study limitations include the retrospective design, the use of an administrative database, and the lack of data regarding long-term opioid use after discharge.

“Increasing coordination of care between [emergency department] physicians and outpatient doctors could mitigate the fears of using conventional gout therapies by [emergency department] providers as well as reduce the risk [for] readmission to the [emergency department], which could ultimately lead to less use of prescription of opioids,” concluded the investigators.

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Dalal DS, Mbuyi N, Shah I, Reinert S, Hilliard R, Reginato A. Prescription opioid use among acute gout patients discharged from the emergency department [published online July 2, 2019]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23928