Intest Res.  2017 Jan;15(1):83-89. 10.5217/ir.2017.15.1.83.

Analysis of the clinical indications for opiate use in inflammatory bowel disease

• Gao Y
• Khan S
• Akerman M
• Sultan K

• KMID: 2368489
• DOI: http://doi.org/10.5217/ir.2017.15.1.83

Abstract

BACKGROUND/AIMS
Opiate use for inflammatory bowel disease (IBD), particularly high-dose (HD) use, is associated with increased mortality. It's assumed that opiate use is directly related to IBD-related complaints, although this hasn't been well defined. Our goal was to determine the indications for opiate use as a first step in developing strategies to prevent or decrease opiate use.
METHODS
A retrospective cohort was formed of adults who were diagnosed with IBD and for whom outpatient evaluations from 2009 to 2014 were documented. Opiate use was defined if opiates were prescribed for a minimum of 30 days over a 365-day period. Individual chart notes were then reviewed to determine the clinical indication(s) for low-dose (LD) and HD opiate use.
RESULTS
After a search of the electronic records of 1,109,277 patients, 3,226 patients with IBD were found. One hundred four patients were identified as opiate users, including 65 patients with Crohn's and 39 with ulcerative colitis; a total of 134 indications were available for these patients. IBD-related complaints accounted for 49.25% of the opiate indications, with abdominal pain (23.13%) being the most common. Overall, opiate use for IBD-related complaints (81.40% vs. 50.82%; P=0.0014) and abdominal pain (44.19% vs. 19.67%; P=0.0071) was more common among HD than among LD.
CONCLUSIONS
Our findings show that most IBD patients using opiates, particularly HD users, used opiates for IBD-related complaints. Future research will need to determine the degree to which these complaints are related to disease activity and to formulate non-opiate pain management strategies for patients with both active and inactive IBD.

Keyword

Inflammatory bowel disease; Crohn disease; Colitis, ulcerative; Opiates; Narcotics

MeSH Terms

Abdominal Pain
Adult
Cohort Studies
Colitis, Ulcerative
Crohn Disease
Humans
Inflammatory Bowel Diseases*
Mortality
Narcotics
Outpatients
Pain Management
Retrospective Studies
Narcotics

Reference

1. Vind I, Riis L, Jess T, et al. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn Colitis database. Am J Gastroenterol. 2006; 101:1274–1282. PMID: 16771949.

2. Ramadas AV, Gunesh S, Thomas GA, Williams GT, Hawthorne AB. Natural history of Crohn's disease in a population-based cohort from Cardiff (1986-2003): a study of changes in medical treatment and surgical resection rates. Gut. 2010; 59:1200–1206. PMID: 20650924.

3. Frolkis AD, Dykeman J, Negrón ME, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2013; 145:996–1006. PMID: 23896172.

4. Abraham NS, Richardson P, Castillo D, Kane SV. Dual therapy with infliximab and immunomodulator reduces one-year rates of hospitalization and surgery among veterans with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2013; 11:1281–1287. PMID: 23792295.

5. Felder JB, Korelitz BI, Rajapakse R, Schwarz S, Horatagis AP, Gleim G. Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a case-control study. Am J Gastroenterol. 2000; 95:1949–1954. PMID: 10950041.

6. Takeuchi K, Smale S, Premchand P, et al. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006; 4:196–202. PMID: 16469680.

7. Long MD, Kappelman MD, Martin CF, Chen W, Anton K, Sandler RS. Role of nonsteroidal anti-inflammatory drugs in exacerbations of inflammatory bowel disease. J Clin Gastroenterol. 2016; 50:152–156. PMID: 26485106.

8. Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infection and mortality in patients with Crohn's disease: more than 5 years of follow-up in the TREAT™ registry. Am J Gastroenterol. 2012; 107:1409–1422. PMID: 22890223.

9. Targownik LE, Nugent Z, Singh H, Bugden S, Bernstein CN. The prevalence and predictors of opioid use in inflammatory bowel disease: a population-based analysis. Am J Gastroenterol. 2014; 109:1613–1620. PMID: 25178702.

10. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011; 171:686–691. PMID: 21482846.

11. Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010; 152:85–92. PMID: 20083827.

12. Kaplan MA, Korelitz BI. Narcotic dependence in inflammatory bowel disease. J Clin Gastroenterol. 1988; 10:275–278. PMID: 2980762.

13. Edwards JT, Radford-Smith GL, Florin TH. Chronic narcotic use in inflammatory bowel disease patients: prevalence and clinical characteristics. J Gastroenterol Hepatol. 2001; 16:1235–1238. PMID: 11903741.

14. Cross RK, Wilson KT, Binion DG. Narcotic use in patients with Crohn's disease. Am J Gastroenterol. 2005; 100:2225–2229. PMID: 16181373.

15. Hanson KA, Loftus EV Jr, Harmsen WS, Diehl NN, Zinsmeister AR, Sandborn WJ. Clinical features and outcome of patients with inflammatory bowel disease who use narcotics: a case-control study. Inflamm Bowel Dis. 2009; 15:772–777. PMID: 19107782.

16. Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007; 5:1424–1429. PMID: 17904915.

17. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004; 126:1504–1517. PMID: 15168363.

18. Gomes P, du Boulay C, Smith CL, Holdstock G. Relationship between disease activity indices and colonoscopic findings in patients with colonic inflammatory bowel disease. Gut. 1986; 27:92–95. PMID: 3949241.

19. Cellier C, Sahmoud T, Froguel E, et al. Correlations between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn's disease: a prospective multicentre study of 121 cases. The Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives. Gut. 1994; 35:231–235. PMID: 7508411.

20. Regueiro M, Kip KE, Schraut W, et al. Crohn's disease activity index does not correlate with endoscopic recurrence one year after ileocolonic resection. Inflamm Bowel Dis. 2011; 17:118–126. PMID: 20848538.

21. Kahan M, Mailis-Gagnon A, Wilson L, Srivastava A. National Opioid Use Guideline Group. Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population. Can Fam Physician. 2011; 57:1257–1266. e407–e418. PMID: 22084455.