Prolonged Opioid Use Following Bladder Tumor Resection for Opioid-Naïve Patients.

Abstract

Bladder cancer patients represent a high-risk group for opioid dependence due to the frequency of surgical procedures. Using MarketScan insurance commercial claims (CC) and Medicare-eligible (ME) databases, we sought to identify whether filling an opioid prescription following initial TURBT resulted in increased odds of prolonged opioid use. We analyzed 43,741 CC and 45,828 ME opioid-naïve patients with a new diagnosis of bladder cancer from 2009 to 2019. Multivariable analyses were completed to assess the odds of prolonged opioid use at 3-6 months based on initial exposure to opioids and initial opioid dose quartile. We performed subgroup analyses by sex and eventual treatment modality. Those who filled an opioid prescription following initial TURBT had greater odds of persistent opioid use (CC: 27% vs 12%, OR 2.14, 95% CI (1.84-2.45), ME: 24% vs 12%, OR 1.95, 95% CI (1.70-2.22). Increasing dosage quartile of opioids was associated with increased odds of prolonged opioid use. Those going on to radical therapy had the highest rates of an initial opioid prescription (31% (CC) and 23% (ME)). Men and women had similar rates of initial prescriptions, but female sex was associated with higher odds of persistent opioid use at 3-6 months in the ME group: OR 1.08, 95% CI (1.01-1.16). Opioids following initial TURBT increase the odds of continued use at 3-6 months, with the greatest odds in those prescribed the highest initial doses. These data suggest that short-term prescriptions have long-term effects, and additional research on opioid use and bladder cancer outcomes is merited.