Prostate Cancer Coverage from Every Angle

Risk of New Persistent Opioid Use After Minor Urologic Procedures

By: Max J. Rosenthal
Posted: Friday, February 28, 2020

Men who are prescribed opioids for low-acuity urologic procedures face “an increased risk of persistent long-term use of opioid medications and a higher risk of serious long-term complications such as hospital visits for an opioid overdose,” according to a Canadian study published in European Urology. Blayne Welk, MD, MSC, FRCSC, of Western University, London, Ontario, Canada, and colleagues recommended that urologists try to limit opioid prescribing in such clinical scenarios.

The study examined routinely collected population-level data from the province of Ontario between 2013 and 2016 and identified 91,083 men who underwent first-time minor urologic procedures during that time. A total of 78% of those men underwent vasectomy; the rest underwent transurethral prostatectomy, urethrotomy, circumcision, spermatocelectomy, or hydrocelectomy. Men with prior opioid use, confounding concurrent procedures, prolonged hospitalization, or cancer were excluded from the study.

Of those men, 32,174 (35%) filled a prescription for opioids within 5 days of their procedures; most prescriptions were for immediate-release codeine (70%), oxycodone (14%), or tramadol (13%). One year after their procedures, those men were at significantly higher risk of developing long-term opioid use (odds ratio = 1.4) and were more likely to require an emergency room visit or hospital admission for opioid intoxication (odds ratio = 3.0).

The study also found that urologists appeared to be more likely to prescribe opioids even though opioids are generally unnecessary for minor urologic procedures; urologists performed 56% of the procedures covered by the study but wrote 81% of the opioid prescriptions. “The reason for this is not clear and represents an important potential area of practice change,” the authors wrote.

Disclosure: The authors reported no conflicts of interest.

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