LAS VEGAS — The rate of chronic opioid use among patients at one inflammatory bowel disease (IBD) clinic was “alarmingly high,” according to researchers here.
Of the 740 patients treated at the clinic during a 34-month period, 10.1% of the group were considered to be chronic opioid users, defined as using opioids for at least 90 days during a 6-month period without any 30 day gaps, reported Bill Hacker, MD, of the University of Kentucky in Lexington, and colleagues.
“That fulfilled our criteria for chronic opioid use,” Hacker said in a presentation at the Crohn’s and Colitis Congress (CCC).
The authors also found that 23.8% of patients were given at least on prescription for opioids to combat pain associated with IBD.
In addition, 8% of patients were considered to have crossed the line from opioid use to opioid misuse. “We defined misuse as a patient who uses four or more prescribers or pharmacies, and if you were a chronic opioid user, you were more likely to misuse the drugs,” Hacker explained.
Hacker’s group retrospectively reviewed all patients seen in the IBD clinic that had received at least one outpatient opioid prescription over a period of 34 months. Data was obtained from the Kentucky drug monitoring system report, and included biologic use, steroid courses, emergency department (ED) visits, readmissions, surgeries, and CT or MRI scans over this period. Composite utilization scores were calculated.
They reported that the mean opioid prescriptions per patient was 18.4. Patients with chronic opioid use were significantly more likely to obtain opioids from four or more prescribers and pharmacies (P=0.0003) and be diagnosed with psychiatric disease (P=0.0095), than patients without chronic opioid use.
Also, patients with chronic opioid use had more than double the average number of ED visits (3.8 versus 1.4, P=0.0125), CT or MRI scans (4.0 versus 1.5, P=0.0007) and a higher composite utilization score (23.9 versus 14.5, P=0.041) than patients without chronic opioid use.
The average morphine-equivalent units these patients were getting was 46 “which is already borderline dangerous without even considering the effect opioid use might be having on their disease,” Hacker noted.
However, Hacker also pointed out that his group could not determine if people with chronic opioid use had more extensive disease and required more resources, or if the chronic opioid use triggered the need for more hospital resources. “We realized when we began this study that this was a question we were not going to be able to separate [out],” he said.
“The rate of chronic opioid use among our inflammatory bowel disease clinic patients is alarmingly high,” the authors concluded. “The patient on chronic opioids is more likely to obtain analgesics from several different providers and pharmacies and be diagnosed with psychiatric disease. Providers should be aware of these red flags.”
“These patients need to be referred to a pain specialist so they can get off the opioids. There are definitely better ways to treat their abdominal pain,” Hacker added.
CCC spokesperson Brent Polk, MD, of Children’s Hospital Los Angeles, told MedPage Today that “The finding that about 25% of patients with inflammatory bowel disease are getting opioid is surprising … the finding that 10% of these patients have chronic opioid use is also alarming.
Polk, who was not involved in the study, pointed out that the study results illustration how “widespread this problem is.”
He suggested that one way to combat patients obtaining multiple opioid prescriptions from multiple clinicians is greater communication between primary care physicians and gastrointestinal specialists.
Hacker disclosed no relevant relationships with industry.