544 Opioid Use in All-Cause Chronic Pruritus

Pruritus occurs frequently following administration of opioids, owing to its effect on μ opioid receptors and peripheral mast cell degranulation. However, the effect of opioids on pruritus in other primary skin conditions is unknown. We performed a retrospective chart review of patients with chronic pruritus, defined as itch lasting >6 weeks, to assess the association of opioid exposure with patient-reported itch severity, using a pruritus visual analogue scale (VAS). Opioid exposure was assessed using the Georgia Prescription Drug Monitoring Program (PDMP) records for opioid medication prescriptions filled within the 90 days prior to the appointment. Our study included 154 patients (40.9% male). Diagnoses included dermatitis (39.1%), urticaria (15.4%), psoriasis (9%), prurigo nodularis/neurodermatitis (4.5%), chronic idiopathic pruritus (13.5%), and other diagnoses (18.6%). Twenty-four patients (15.6%) met criteria for opioid exposure. Opioid-exposed participants reported greater mean severity of itch, indicated by higher pruritus VAS scores (5.58 vs. 4.17, p=0.034). In addition, increased total morphine equivalents trended towards greater itch severity, although this did not reach statistical significance (4.17 vs. 5.23 vs. 6.00 for total morphine equivalents of 0, <1,000 mg, and ≥1,000 mg, respectively, p=0.087). This study highlights that opioid use may enhance pruritus in many opioid-unrelated primary skin conditions. In the setting of the current opioid epidemic, dermatologists are uniquely poised to recognize and potentially address an uncomfortable opioid side effect: pruritus. Future studies are needed to explore causative nature of opioids in the population. This knowledge may be able to provide physicians with a deeper understanding with which to fight the opioid epidemic and may motivate patients in finding non-opiate pain management strategies.