Predictors of chronic opioid use in IBD

April 8, 2025

Issue 07

Clinical Question

What factors predict chronic opioid use in IBD patients?

Editor’s Bottom Line

Despite a decline over time, rates of opioid use remain high among patients with IBD and point to a need for better pain management strategies.

Reference

Nørgård BM, Thorarinsson CT, Nielsen J, et al. Predictors for Chronic Opioid Use in Patients with Inflammatory Bowel Disease: A Population-Based Cohort Study. Am J Gastroenterol. Epub ahead of print Feb 5, 2025; https://journals.lww.com/ajg.aspx

Synopsis

To identify rates and predictors of chronic opioid use in IBD patients, Danish and American researchers examined data from a nationwide Danish IBD cohort gathered between 1996 and 2021. The analysis included 15,092 adult patients with Crohn’s disease (CD) and 30,416 patients with ulcerative colitis (UC). Chronic opioid use was defined as at least one opioid prescription in at least 2 of 3 consecutive quarters.

The authors found that 27.4% of CD patients met chronic opioid use criteria during a median follow-up of 7.35 years (Interquartile Range [IQR]: 3.40–13.66 years), while 22.3% of UC patients did the same during a median 8.8 years of follow-up (IQR: 4.20–15.22 years). Notably, the proportion of chronic opioid users declined from 34% of CD patients between 1996–2002 to 14.3% between 2016–2021, and from 35.8% to 9.3% during the same periods, respectively, among UC patients.

Statistical analyses revealed that in both the CD and UC populations, the three most important predictors of chronic opioid use were IBD surgery, (adjusted Hazard Ratio (aHR) in CD: 4.20; 95% Confidence Interval [CI], 3.72–4.75 and aHR in UC: 4.81; 95% CI, 4.20–5.52), baseline use of hypnotics or sedatives (aHR in CD: 2.02; 95% CI, 1.81–2.25 and aHR in UC: 2.11; 95% CI, 1.95–2.29) and age of 50 years or older (aHR in CD: 1.92; 95% CI, 1.77–2.09 and aHR in UC: 2.62; 95% CI, 2.44–2.82).

Sub-analysis of patients who did not undergo surgery during the study period showed that use of corticosteroids, hypnotics or sedatives and age 50 or older were the strongest predictors of chronic opioid use in these patients.

Details

Study Design: Nationwide cohort
Funding: Aage og Johanne Louise Hansens Fond and Østifterne

Allocation: None
Setting: Multicenter
Level of Evidence: 2b