PD14-01 INCREASED RISK OF NEW PERSISTENT OPIOID USE IN PEDIATRIC AND YOUNG ADULT UROLITHIASIS PATIENTS PRESCRIBED OPIOIDS AT PRESENTATION
Bibliographic record
Abstract
You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (PD14)1 Apr 2020PD14-01 INCREASED RISK OF NEW PERSISTENT OPIOID USE IN PEDIATRIC AND YOUNG ADULT UROLITHIASIS PATIENTS PRESCRIBED OPIOIDS AT PRESENTATION Gregory Hosier*, Thomas McGregor, Darren Beiko, Michael Di Lena, Christopher Booth, Marlo Whitehead, and D. Robert Siemens Gregory Hosier*Gregory Hosier* More articles by this author , Thomas McGregorThomas McGregor More articles by this author , Darren BeikoDarren Beiko More articles by this author , Michael Di LenaMichael Di Lena More articles by this author , Christopher BoothChristopher Booth More articles by this author , Marlo WhiteheadMarlo Whitehead More articles by this author , and D. Robert SiemensD. Robert Siemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000848.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pediatric and young adults are a vulnerable patient population for development of addiction after opioid exposure. The incidence of pediatric urolithiasis has been steadily increasing for the past several decades. However, the long-term impact of opioid prescribing in pediatric and young adult patients with urolithiasis is not known. Our objective was to describe rates of opioid prescription and identify risk factors for persistent opioid use in patients <25 years old with urolithiasis. METHODS: Using previously validated linked administrative databases we performed a population-based retrospective study of all opioid-naïve patients <25 years old with a diagnosis of urolithiasis between July 1, 2013 and September 30, 2017 in Ontario, Canada. All family practitioner, Emergency department, 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 urolithiasis visit. Secondary outcomes were opioid addiction and opioid overdose. 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 (OME). There was persistent opioid use in 313 (8.1%) patients who filled an initial opioid prescription. Those prescribed an opioid initially had a significantly higher risk of persistent opioid use (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.5–2.3), opioid addiction (OR 3.6, 95% CI 1.2-10.6), and opioid overdose (OR 2.8, 95% CI 0.9-8.5) compared to those without initial opioid exposure. In adjusted analysis, initial exposure of >300 OME (OR 2.2, 95% CI 1.5-3.3), history of mental illness (OR 1.3, 95% CI 1.0-1.7), and need for surgery (OR 1.7, 95% CI 1.2-2.3) were all risk factors for persistent opioid use (Table 1). CONCLUSIONS: Among urolithiasis patients <25 years old, 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 addiction and overdose. Source of Funding: This work was funded by the PSI foundation. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e272-e272 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Hosier* More articles by this author Thomas McGregor More articles by this author Darren Beiko More articles by this author Michael Di Lena More articles by this author Christopher Booth More articles by this author Marlo Whitehead More articles by this author D. Robert Siemens More articles by this author Expand All Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".