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Study: One-fifth of Patients with Cirrhosis Prescribed Opioids During Clinic Visits


In a new study of patients with cirrhosis, over two-thirds of outpatient clinic visits that included an opioid prescription were with primary care physicians.


Nearly 1 in 5 outpatient clinic visits among patients with cirrhosis involved an opioid prescription, and most of these visits were with a primary care physician (PCP), according to new research presented at The Liver Meeting Digital Experience held by the American Association for the Study of Liver Diseases (AASLD).

“Pain management for patients with cirrhosis can be difficult, and providers may feel they have few options other than opioids,” said the study’s lead author Anna H. Lee, MD, an internist at the Ronald Reagan UCLA Medical Center, in an AASLD press release. “Since opioid prescriptions are still largely fueling the opioid epidemic in our country, we wanted to observe these prescription patterns in patients with cirrhosis.”

It is important that all prescribers are aware of the additional harms associated with opioid use in patients with cirrhosis, such as the risk of hepatic encephalopathy and increased health care use, explained Lee.

Lee and colleagues used data from the National Ambulatory Medical Care Survey (NAMCS) from 2006 to 2016 to identify ambulatory care visits among patients diagnosed with cirrhosis.

For ambulatory care visits that involved an opioid prescription, investigators assessed the type of opioid, any associated pain diagnosis, and whether it was an old or new prescription. Also, researchers compared the characteristics of patients and providers in the visits with and without an opioid prescription.

Of the 10.1 million ambulatory care visits with a diagnosis of cirrhosis, the results showed:

  • 53% of visits were with gastroenterologists, including hepatologists; 41% with PCPs.
  • An opioid was prescribed in 17% (1.7 million) of the visits. Of these prescriptions, 91% involved prescription renewal rather than a new prescription.
  • 68% of visits that included an opioid prescription were with PCPs, compared to 29% with gastroenterologists.
  • Oxycodone and hydrocodone were the most frequently prescribed opioids.

In addition, Lee and colleagues found that there was a documented pain diagnosis in 41% of visits that included an opioid prescription. Among these patients, the most common pain condition was musculoskeletal pain, followed by gastrointestinal pain.

“Since most opioid prescriptions are associated with primary care visits, we should target our educational efforts about harms toward primary care providers,” stated Lee. “All clinicians can benefit from more education about safe options for managing pain disorders.”

Reference: Lee A, et al. Opioid prescription patters among ambulatory patients with cirrhosis: A nationwide analysis. Abstract (655) presented at: TLM 2021; held online November 12-15, 2021.

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