Kidney Stones and Risk of Narcotic Use

Purpose: The rise in opioid related deaths and addiction has been linked to physician prescribing. Opioids are commonly prescribed to patients with renal colic due to nephrolithiasis. The aim of this study was to describe the relationship between nephrolithiasis and opioid use in the United States. Materials and Methods: Using the NHANES (National Health and Nutrition Examination Survey) we analyzed the relationship between a self-reported history of kidney stones and current opioid use in a nationally representative sample. Results: Current opioid use was significantly greater among those who did vs did not report a history of kidney stones (10.9%, 95% CI 9.1-12.9 vs 6.1%, 95% CI 5.4-6.8). The prevalence of opioid use increased with the number of kidney stones passed, reaching 13.7% (95% CI 11.1-16.9) in subjects who had passed 2 or more stones (p < 0.001). On multivariable logistic regression analysis adjusting for age, gender, smoking status, number of health care visits in the last year and comorbid conditions nephrolithiasis was independently associated with opioid based medication use (OR 1.27, 95% CI 1.07-1.49, p = 0.006). Conclusions: The association between a history of kidney stones and current narcotic use suggests that nephrolithiasis may be a risk factor for long-term opioid use. While this study is limited by the cross-sectional design and the absence of detailed stone histories, it adds to the evidence that altering pain management strategies may be beneficial in this population.