In the Journals

Heavy use of prescription opiates for IBD may increase mortality rates

Heavy use of opiates among patients with inflammatory bowel disease correlated with increased rates of all-cause premature mortality, according to a recently published study.

“Opiate prescriptions are increasing worldwide in individuals with chronic noncancer pain, and individuals with IBD can now be included in this group,” Nicholas E. Burr, MBBS, from the University of Leeds, United Kingdom, and colleagues wrote. “We feel that there should be the same pharmacovigilance applied to prescribing opiates for those with IBD, especially as heavy use ([more than three] prescriptions per calendar year) was associated with the worst outcomes.”

According to Burr, recent data showed that prescription for weaker opiates doubled in the U.K. between 2005 and 2012 and prescriptions for strong opiates increased sixfold.

To explore the trends in opiates prescriptions for IBD and their potential associated with mortality, the researchers analyzed the data of 3,517 patients with Crohn’s disease and 5,349 patients with ulcerative colitis. Overall, 764 of those with CD and 722 of those with UC used opiates.

The number of patients with IBD who received an opiate prescription increased from 10% between 1990 and 1993 in the U.K. to 30% between 2010 and 2013 (P < .005), including codeine (P = .008), tramadol (P < .005) and other strong opiates (P < .005).

Compared with non-users, those with IBD who used opiates had a longer duration of IBD and were more likely women, smokers and older at diagnosis (P < .005).

Patients with IBD who used opiates were also more likely to have undergone gastrointestinal resectional surgery, more often had a Charlson comorbidity score higher than 2, and to have registered with a general practitioner who had a higher rate of ever prescribing opiates to patients with IBD (P < .005).

During follow-up, the researchers found a significant association between heavy use of any opiate and increased premature mortality in patients with UC (HR = 1.67; 95% CI, 1.25-2.23), especially with heavy use of codeine (HR = 1.83; 95% CI, 1.1-3.05). While the largest association was with heavy use of strong opiates (HR = 3.3; 95% CI, 1.77-6.18), moderate use was still significant (HR = 2.44; 95% CI, 1.16-5.15).

For patients with CD, heavy use of strong opiates correlated with premature mortality (HR = 2.18; 95% CI, 1.2-3.95). However, the researchers observed no association between mortality and prescription of any opiate medication or codeine alone.

Overall, heavy use of strong opiates correlated significantly with premature mortality in both patients with CD (HR = 2.04; 95% CI, 1.14-3.65) and UC (HR = 2.47; 95% CI, 1.41-4.33), compared with use of any opiates.

“Whether the opiates are attributing to this increased mortality within the defined time period or are associated with another causative factor is not certain,” the researchers concluded. “Designing and conducting a large scale randomized controlled trial may not be feasible. Despite the limitations of observational data, population datasets may be the best method to investigate a potential effect.”- by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

Heavy use of opiates among patients with inflammatory bowel disease correlated with increased rates of all-cause premature mortality, according to a recently published study.

“Opiate prescriptions are increasing worldwide in individuals with chronic noncancer pain, and individuals with IBD can now be included in this group,” Nicholas E. Burr, MBBS, from the University of Leeds, United Kingdom, and colleagues wrote. “We feel that there should be the same pharmacovigilance applied to prescribing opiates for those with IBD, especially as heavy use ([more than three] prescriptions per calendar year) was associated with the worst outcomes.”

According to Burr, recent data showed that prescription for weaker opiates doubled in the U.K. between 2005 and 2012 and prescriptions for strong opiates increased sixfold.

To explore the trends in opiates prescriptions for IBD and their potential associated with mortality, the researchers analyzed the data of 3,517 patients with Crohn’s disease and 5,349 patients with ulcerative colitis. Overall, 764 of those with CD and 722 of those with UC used opiates.

The number of patients with IBD who received an opiate prescription increased from 10% between 1990 and 1993 in the U.K. to 30% between 2010 and 2013 (P < .005), including codeine (P = .008), tramadol (P < .005) and other strong opiates (P < .005).

Compared with non-users, those with IBD who used opiates had a longer duration of IBD and were more likely women, smokers and older at diagnosis (P < .005).

Patients with IBD who used opiates were also more likely to have undergone gastrointestinal resectional surgery, more often had a Charlson comorbidity score higher than 2, and to have registered with a general practitioner who had a higher rate of ever prescribing opiates to patients with IBD (P < .005).

During follow-up, the researchers found a significant association between heavy use of any opiate and increased premature mortality in patients with UC (HR = 1.67; 95% CI, 1.25-2.23), especially with heavy use of codeine (HR = 1.83; 95% CI, 1.1-3.05). While the largest association was with heavy use of strong opiates (HR = 3.3; 95% CI, 1.77-6.18), moderate use was still significant (HR = 2.44; 95% CI, 1.16-5.15).

For patients with CD, heavy use of strong opiates correlated with premature mortality (HR = 2.18; 95% CI, 1.2-3.95). However, the researchers observed no association between mortality and prescription of any opiate medication or codeine alone.

Overall, heavy use of strong opiates correlated significantly with premature mortality in both patients with CD (HR = 2.04; 95% CI, 1.14-3.65) and UC (HR = 2.47; 95% CI, 1.41-4.33), compared with use of any opiates.

“Whether the opiates are attributing to this increased mortality within the defined time period or are associated with another causative factor is not certain,” the researchers concluded. “Designing and conducting a large scale randomized controlled trial may not be feasible. Despite the limitations of observational data, population datasets may be the best method to investigate a potential effect.”- by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.