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Cutting opioids in IBD may reduce emergencies, costs
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Patients with inflammatory bowel disease with extended opioid use experience more emergency encounters and utilize more health care, resulting in higher costs, according to data published in Inflammatory Bowel Diseases.
Anita Afzali, MD, MPH, FACG, of the division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center, and colleagues wrote that chronic pain is a critical issue for patients with IBD and exploring the impact of opioids has become an important aspect of research in this population.
“Recent studies show that opioid use disorder–related diagnoses are increasing among patients hospitalized with IBD and that a majority of patients with IBD are prescribed narcotics during hospitalizations,” they wrote. “Although short-term opioid use for acute pain after major flares or surgery is expected, the impact of chronic or extended opioid use on health care utilization among patients with IBD has not been evaluated.”
Researchers analyzed data from the Truven Health MarketScan research databases and identified 76,171 patients with IBD in 2009. They then assessed the occurrence of an emergent encounter in 2010, as well as health care costs.
Patients included in the analysis had a total of 35,993 emergency encounters in 2010, an overall rate of 0.47 per patient-year. However, those encounters were limited to a relatively small portion of patients, just 6.9%. In 2009, 28,194 patients (37%) had a prescription for opioids. Of these, 6,081 (21.6%) had an opioid supply of at least 60 days, which researchers defined as extended use.
Extended opioid use in 2009 was associated with higher odds of an emergent encounter in 2010 (OR = 1.82; 95% CI, 1.67–1.98), as well as a higher incidence rate of emergency encounters (IRR = 2.07; 95% CI, 1.91–2.24).
In 2010, the median total charges for patients were $5,372. Extended opioid use was associated with higher odds of being in the top quartile of costs (OR = 1.9; 95% CI, 1.79–2.02).
Afzali and colleagues also found that depression was a strong predictor of extended opioid use (OR = 2.64; 95% CI, 2.49–2.81) and encouraged providers to evaluate patients for pain and psychological comorbidities with the overall goal of reducing concomitant use of opioids.
“Although extended opioid users only made up 8% of the IBD patients in our 2009 cohort, they comprised 17.3% of patients who experienced an emergent encounter in 2010 and 15.6% of patients in the top quartile of costs in 2010,” they wrote. “Taken together, the past studies and our findings indicate that reducing overall opioid prescriptions among IBD patients has the potential to reduce health care utilization and overall health care costs.”– by Alex Young
Disclosures: Afzali reports consulting or speaking for AbbVie, Janssen, Pfizer, Takeda and UCB. The remaining authors report no relevant financial disclosures.
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