Abstract

Increasing Prescription of Opiates and Mortality in Patients with Inflammatory Bowel Diseases in England

Burr NE1, Smith C2, West R2, Hull MA1, Subramanian V3. Clin Gastroenterol Hepatol. 2017 Oct 24. pii: S1542-3565(17)31247-8. doi: 10.1016/j.cgh.2017.10.022. [Epub ahead of print]
 
     
Author information

1 Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.

2 Leeds Institute of Health Sciences, University of Leeds, United Kingdom.

3 Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. Electronic address: v.subramamanian@leeds.ac.uk.

Abstract

BACKGROUND & AIMS: The prescription of opiate medications is increasing. Individuals with inflammatory bowel diseases (IBD) can develop serious complications from opiate use, but few data are available on the prescription of these drugs to patients with IBD. We examined trends in prescriptions of opiates and their association with all-cause mortality in individuals with IBD.

METHODS: We performed a retrospective cohort study of 3517 individuals with Crohn's disease (CD) and 5349 with ulcerative colitis (UC) using the primary care database ResearchOne, which holds de-identified clinical and administrative information from the health records of approximately 6 million persons in England. We explored trends in prescriptions of all opiates, codeine, tramadol, or strong opiates, separately during the years 1990 through 2013. Associations between opiates and all-cause mortality were examined using propensity score-matched analysis.

RESULTS: There was a statistically significant increase in the prescription of opiate medications with 10% of subjects receiving an opiate prescription during the years 1990 through 1993 compared to 30% in 2010 through 2013 (chi2 for trend, P<.005). Prescription of strong opiates was significantly associated with increased premature mortality of patients with CD (heavy use) or UC (moderate or heavy use). There was a similar, significant association for the heavy use of any opiate or codeine used alone in those with a diagnosis of UC. Use of tramadol alone, or in combination with codeine, was not associated with premature mortality in either CD or UC.

CONCLUSION: In an analysis of primary care patients with IBD in England, we found prescriptions for opiate drugs to have increased significantly from 1990 through 2013. Heavy use of strong opiates among patients with IBD was associated with increased all-cause premature mortality. Residual confounding variables might account for observed associations. The adverse effects of opiate medications for non-cancer pain have been established; we now associate their use with increased all-cause premature mortality in individuals with IBD.

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