Opioids are frequently prescribed to patients with cirrhosis, often without a pain diagnosis, according to a research letter published online Dec. 8 in Clinical Gastroenterology and Hepatology.

Anna H. Lee, M.D., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues conducted a retrospective study using cross-sectional data of U.S. ambulatory visits for patients older than 18 years with cirrhosis during 2006 to 2015 from the National Ambulatory Medical Care Survey. The primary outcome was the presence of an opioid prescription, and characteristics associated with opioid prescriptions were analyzed.

The researchers identified 516 visits involving patients with cirrhosis, representing 12,345,196 weighted visits. Overall, 19 percent of visits resulted in an opioid prescription; 93 percent were renewals. Pain diagnoses were seen in 30 and 33 percent of cirrhosis visits and visits with an opioid prescription, respectively. Pain diagnoses from opioid prescription visits were musculoskeletal/joint-related, endocrine, neurologic, genitourinary, gastrointestinal, and infectious in 41, 25, 22, 5, 4, and 3 percent, respectively. Among patients with cirrhosis, opiate prescriptions were predicted by primary care physician specialty, provider continuity, patients' older age, male gender, and Black race in a multivariate analysis (odds ratios [95 percent confidence intervals], 3.40 [1.58 to 7.34], 2.35 [1.27 to 4.34], 1.34 [1.08 to 1.67], 1.94 [1.00 to 3.74], and 2.71 [1.23 to 5.94], respectively).

"Encounters involving older, male, Black patients, and primary care physicians were associated with prescription risk," the authors write. "De-escalation efforts should be individualized towards these patient communities and prescribers, who may be less familiar with the patient population and should be educated on risks of their opioid use."