Opioid use ‘alarmingly high’ among patients with IBD

LAS VEGAS — Researchers from University of Kentucky reported that chronic use of opioid medications to manage abdominal pain was “alarmingly high” among patients at their inflammatory bowel disease clinic.

In their late-breaking abstract presented at the Crohn’s & Colitis Congress, they noted that providers should be aware of several “red flags” that indicate a patient may be at risk for chronic opioid use, including a psychiatric diagnosis and a tendency to obtain analgesics from different providers and pharmacies.

“We know that opioid use in nonpalliative chronic pain is no longer the standard of care,” Bill Hacker, MD, of the University of Kentucky, told Healio Gastroenterology and Liver Disease. “We also know multiple mechanisms [by which] opioids can complicate IBD. Unfortunately, there isn't a ton of literature evaluating outcomes of chronic opioid use in IBD.”

To determine the extent of opioid use within their IBD clinic and its impact on health care use and disease course, Hacker and colleagues reviewed data from the Kentucky drug monitoring system reporting on all IBD patients who received one or more outpatient opioid prescriptions over 34 months. They defined chronic opioid use as having at least 90 days’ worth of opioid medication during a 6-month period without any 30-day gaps.

The investigators also evaluated data on use of biologics and steroids, emergency department visits and readmission, surgeries and CT or MRI scans over the same period.

Of the 740 patients seen at their IBD clinic during the study period, 23.8% received at least one opioid prescription (mean opioid prescriptions per patient, 18.4 ± 20). This figure was “astonishing,” Hacker said, adding that “average opioid use was also higher than anticipated at 42.7 daily morphine equivalents.”

They also found that 10.1% of all patients met criteria for chronic opioid use, and that they were significantly more likely to obtain opioids from four or more prescribers and pharmacies (P = .0003) and receive at diagnosis of psychiatric disease (P = .0095).

These patients also visited the ED (3.8 vs. 1.4, P = .0125) and had CT or MRI scans (4 vs. 1.5, P = .0007) more than twice as often on average, and showed significantly higher composite utilization scores (23.9 vs. 14.5, P = .041) compared with patients who did not use opioids chronically.

Hacker and colleagues concluded that alternative pain management options should be considered in the future, and that providers should collaborate with addiction and pain specialists in the treatment of their IBD patients’ chronic pain.

“The bottom line is that we associated chronic opioid use to higher health care utilization in an IBD clinic population,” Hacker said. – by Adam Leitenberger

Reference:

Hacker B, et al. P216. Presented at: Crohn’s & Colitis Congress; Jan. 19-20, 2018; Las Vegas, NV.

Disclosures: The authors report no relevant financial disclosures.