Original Article
Alimentary Tract
Exposure to Intravenous Opioids Is Associated With Future Exposure to Opioids in Hospitalized Patients With Inflammatory Bowel Diseases

https://doi.org/10.1016/j.cgh.2019.12.024Get rights and content

Abstract

Background & Aims

Opioid use is associated with increased mortality in patients with inflammatory bowel diseases (IBD). Hospitalized patients with IBD often receive high-potency intravenous opioids (IVOPIs). It is not known whether exposure to IVOPIs affects post-discharge opioid use or complications. We investigated the association between inpatient administration of IVOPIs and a post-discharge opioid prescription (OPIRx) in patients with IBD.

Methods

We performed a retrospective cohort study of 862 adults with IBD hospitalized at a large urban academic health system from March 1, 2017 through April 10, 2018. We collected clinical data from the electronic health records and used multivariable mixed-effect logistic regression to assess the association between inpatient opioid exposure and OPIRx-within 12 months while adjusting for confounders. IV and non-IVOPI exposures were evaluated as binary variables. IVOPI exposure was also evaluated as a continuous variable in IV morphine mg equivalents/length of stay (IVMMEs/day).

Results

Multivariable mixed-effect logistic regression demonstrated a significant association between IVOPIs and OPIRx (IV vs no IVOPIs odds ratio [OR], 3.3; 95% CI, 1.7–6.4 and IVMMEs/day OR, 1.1; 95% CI, 1.0–1.1). Subgroup analysis of patients with IBD flares (n = 621) identified a significant association between IVOPIs and OPIRx (IV vs no IVOPIs OR, 5.4; 95% CI, 2.6–11.0). Among patients who did not receive IVOPIs, there was a significant association between oral/transdermal opioids and OPIRx (non-IVOPIs vs no opioids OR, 4.2; 95% CI, 1.0–16.8).

Conclusions

Inpatient IV and non-IV opioid use are associated with post-discharge opioid exposure in patients with IBD, with a dose-dependent effect. Alternative analgesics should be considered for hospitalized patients with IBD, to minimize risk of future opioid use.

Section snippets

Study Design and Patient Enrollment

This was a retrospective cohort study of patients ≥18 years of age with a discharge problem list diagnosis of IBD (International Classification of Diseases–Tenth Revision–Clinical Modification: K50x for Crohn’s disease [CD] and K51x for ulcerative colitis [UC]) who were hospitalized at any of 3 urban hospitals in the University of Pennsylvania Health System between March 1, 2017, and April 10, 2018. IBD patients admitted to the emergency department observation unit (EDOU) and the following

Results

We identified 1419 hospitalizations with an associated IBD diagnosis during the study period. Among these, 976 hospitalizations were associated with ≥1 outpatient gastroenterology or CRS office visit, among which 862 hospitalizations representing 601 unique patients were on inpatient services that typically manage IBD and related complications (ie, primary analysis), and 621 hospitalizations representing 423 unique patients had IBD listed as the primary discharge diagnosis or the secondary

Discussion

In this study, we found that IBD patients who received IVOPIs had significantly higher odds of OPIRx compared with patients who did not receive IVOPIs after controlling for factors related to IBD severity, psychiatric comorbidities, preadmission opioid use, pain scores, and other confounders. We observed this relationship in 2 populations: IBD patients admitted to hospital services that commonly manage IBD and related complications, and patients admitted specifically for IBD flares. We

References (16)

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Conflicts of interest These authors disclose the following: James Lewis has received consulting honorarium from Pfizer, Gilead, UCB, Janssen Orthobiotech, Celgene, AbbVie, Samsung Bioepis, Bridge Biotherapeutics, Merck, Eli Lilly, Bristol-Myers Squibb, Arena Pharmaceuticals, and Takeda. He has received research funding from Takeda, Janssen and Nestle Health Sciences. Gary Lichtenstein has received compensation for research/grant support, support for lectures, and for scientific advisory committee from the following companies: Abbott, Actavis, Alaven, CellCeutrix, Celgene, Clinical Advances in Gastroenterology, Ferring, Gastro-Hep Communications, Gilead, Hospira, Ironwood, Janssen Orthobiotech, Luitpold/American Regent, Merck, McMahon Publishing, Pfizer Pharmaceuticals, Prometheus Laboratories, Inc., Romark, Salix Pharmaceuticals, Santarus, Shire Pharmaceuticals, Slack, Inc., Springer Science and Business Media, Takeda, UCB, and Up-To-Date. The remaining authors disclose no conflicts.

Funding The following grant is the only funding source for this study: T32-DK007740.

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