TOPLINE:

Patients with inflammatory bowel disease (IBD) who filled an opioid prescription within 7 days of discharge from an emergency department (ED) or hospital had higher odds for ED revisits, rehospitalization, and medication escalation than patients who did not fill such prescriptions.

METHODOLOGY:

• Opioids are often prescribed to manage pain in patients with IBD, but there is limited evidence of their analgesic benefit and concern that their use may worsen outcomes in this patient population.
• Researchers retrospectively analyzed private health insurance claims of 35,890 adults with IBD (mean age, 42.4 years; 54.9% female) who had an ED visit, hospitalization, or both between 2017 and 2021 and who had not received an opioid prescription in the prior 6 months.
• Patients (17,108, Crohn’s disease; 18,782, ulcerative colitis) were grouped into those who received an opioid prescription within 7 days of discharge and those who did not. Common opioids included hydrocodone, oxycodone, and tramadol. Overall, 7892 (22%) patients filled an opioid prescription within 7 days of discharge.
• Outcomes, including IBD-related surgery, ED visits, hospitalizations, and escalation of IBD-associated medications, were assessed at 1, 3, and 6 months from day 8 after discharge.

TAKEAWAY:

• Patients with IBD who filled an opioid prescription were more likely than those who didn’t to have ED revisits (adjusted odds ratio [aOR], 1.27; P < .001) and rehospitalizations (aOR, 1.33; P < .001) at 1 month and an escalation of IBD-associated medications at 6 months (aOR, 1.11; P = .013).
• Overall, filling an opioid prescription was associated with increased odds of receiving corticosteroid prescriptions at 1 month (aOR, 1.11; P = .015) and 6 months (aOR, 1.09; P = .005), and with repeat opioid prescriptions at 1 month (aOR, 4.25), 3 months (aOR, 2.71), and 6 months (aOR, 2.31; P < .001 for all).
• There were a few differences in outcomes between patients with Crohn’s disease and those with ulcerative colitis. Patients with Crohn’s disease who filled an opioid prescription were at a higher risk for IBD treatment escalation at months 3 and 6, while no increased risk was seen in patients with ulcerative colitis. Patients with ulcerative colitis who received an opioid prescription were at a higher risk for corticosteroid use at 1 month, while no increased risk was seen in patients with Crohn’s disease.

IN PRACTICE:

“The results of this study reinforce similar findings in previous investigations and highlight the serious adverse effects associated with opioid use in IBD patients. Healthcare providers should limit prescribing opioids to individuals with IBD as much as possible in this setting,” the study authors wrote.

SOURCE:

This study, led by Heinle J. Westley, MPH, Division of Gastroenterology and Hepatology, Penn State College of Medicine in Hershey, Pennsylvania, was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

Follow-up was limited to 6 months, preventing the assessment of long-term outcomes. The study did not account for patients who were given an opioid during their hospitalization but were not prescribed one within 7 days of discharge. The database does not include Medicare or Medicaid claims, limiting the generalizability, and it lacks information on the reason for admission.

DISCLOSURES:

This study received support from the National Institute of Diabetes and Digestive and Kidney Diseases, the Peter and Marshia Carlino Professorship in Medicine, and the M.E.W. Career Development Professorship in Gastroenterology. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.