In the Journals

Inpatient opioids linked with future opioid use in IBD

Patients with inflammatory bowel disease who received intravenous or non-intravenous opioids while in the hospital are more likely to be exposed to opioids after they are discharged, according to study results.

Gary R. Lichtenstein, MD, of the Perelman Center for Advanced Medicine at the University of Pennsylvania, and colleagues wrote that previous evidence has shown that opioid use is associated with severe infections and increased mortality among patients with IBD, as well as other complications.

“Despite these concerns, opioids are commonly prescribed to IBD patients in the outpatient setting and to as many as 70% of IBD patients who are hospitalized,” they wrote. “There are currently no data to inform providers if inpatient opioid prescribing may promote post-discharge opioid use and complications in the IBD population.”

Researchers performed a retrospective cohort study comprising 862 adults with IBD who were hospitalized at any of the three urban hospitals within the University of Pennsylvania Health System between 2017 and 2018. They used electronic health records to assess the association between inpatient opioid exposure and post-discharge opioid prescriptions (OPIRx) within 12 months, after adjusting for confounders. They assessed both intravenous and non-intravenous opioid exposure and also evaluated IV exposure as a continuous variable as IV morphine mg equivalents/length of stay (IVMMEs/day).

Lichtenstein and colleagues wrote that their analysis revealed an association between IV opioid exposure and OPIRx compared with patients who did not receive IV opioids (OR = 3.3; 95% CI, 1.7-6.4). Among patients with an IBD flare, the association was even stronger (OR = 5.4; 95% CI, 2.6-11). There was also an association between oral or transdermal opioid exposure and OPIRx compared with patients no did not receive opioids (OR = 4.2; 95% CI, 1-16.8).

Lichtenstein and colleagues wrote that additional research is needed to determine the benefits of opioid prescribing practices for patients with IBD.

“We observed a positive dose response with higher inpatient dose exposure being associated with greater outpatient opioid prescribing,” they wrote. “With ongoing concerns regarding complications of opioid therapy, we hope that these findings will guide inpatient providers to consider alternative analgesics when managing the pain of this vulnerable population.” – by Alex Young

Disclosure: Lichtenstein reports receiving compensation for research/grant support, support for lectures, and for scientific advisory committee from 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, Incorporated, Springer Science and Business Media, Takeda, UCB, and Up-To-Date. Please see the full study for all other authors’ relevant financial disclosures.

Patients with inflammatory bowel disease who received intravenous or non-intravenous opioids while in the hospital are more likely to be exposed to opioids after they are discharged, according to study results.

Gary R. Lichtenstein, MD, of the Perelman Center for Advanced Medicine at the University of Pennsylvania, and colleagues wrote that previous evidence has shown that opioid use is associated with severe infections and increased mortality among patients with IBD, as well as other complications.

“Despite these concerns, opioids are commonly prescribed to IBD patients in the outpatient setting and to as many as 70% of IBD patients who are hospitalized,” they wrote. “There are currently no data to inform providers if inpatient opioid prescribing may promote post-discharge opioid use and complications in the IBD population.”

Researchers performed a retrospective cohort study comprising 862 adults with IBD who were hospitalized at any of the three urban hospitals within the University of Pennsylvania Health System between 2017 and 2018. They used electronic health records to assess the association between inpatient opioid exposure and post-discharge opioid prescriptions (OPIRx) within 12 months, after adjusting for confounders. They assessed both intravenous and non-intravenous opioid exposure and also evaluated IV exposure as a continuous variable as IV morphine mg equivalents/length of stay (IVMMEs/day).

Lichtenstein and colleagues wrote that their analysis revealed an association between IV opioid exposure and OPIRx compared with patients who did not receive IV opioids (OR = 3.3; 95% CI, 1.7-6.4). Among patients with an IBD flare, the association was even stronger (OR = 5.4; 95% CI, 2.6-11). There was also an association between oral or transdermal opioid exposure and OPIRx compared with patients no did not receive opioids (OR = 4.2; 95% CI, 1-16.8).

Lichtenstein and colleagues wrote that additional research is needed to determine the benefits of opioid prescribing practices for patients with IBD.

“We observed a positive dose response with higher inpatient dose exposure being associated with greater outpatient opioid prescribing,” they wrote. “With ongoing concerns regarding complications of opioid therapy, we hope that these findings will guide inpatient providers to consider alternative analgesics when managing the pain of this vulnerable population.” – by Alex Young

Disclosure: Lichtenstein reports receiving compensation for research/grant support, support for lectures, and for scientific advisory committee from 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, Incorporated, Springer Science and Business Media, Takeda, UCB, and Up-To-Date. Please see the full study for all other authors’ relevant financial disclosures.

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