Inflamm Bowel Dis. 2024 Sep 3:izae188. doi: 10.1093/ibd/izae188. Online ahead of print.

Charles N Bernstein ^1 2, John D Fisk ³, Randy Walld ⁴, James M Bolton ⁵, Jitender Sareen ⁵, Scott B Patten ⁶, Alexander Singer ⁷, Lisa M Lix ⁸, Carol A Hitchon ¹, Renée El-Gabalawy ^9 10, Alan Katz ^4 7 8, Lesley A Graff ^2 9, Ruth Ann Marrie ^1 2 8; CIHR Team in Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immunoinflammatory Disease

Collaborators

• CIHR Team in Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immunoinflammatory Disease: 

Ruth Ann Marrie, James M Bolton, Jitender Sareen, Scott B Patten, Alexander Singer, Lisa M Lix, Carol A Hitchon, Renée El-Gabalawy, Alan Katz, John D Fisk, Charles N Bernstein, Lesley Graff, Lindsay Berrigan, Ryan Zarychanski, Christine Peschken, James Marriott, Kaarina Kowalec, Lindsay Berrigan

Author information

¹Rady Faculty of Health Sciences, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

²IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.

³Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

⁴Rady Faculty of Health Sciences, Manitoba Centre for Health Policy, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

⁵Rady Faculty of Health Sciences, Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

⁶Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

⁷Rady Faculty of Health Sciences, Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

⁸Rady Faculty of Health Sciences, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

⁹Rady Faculty of Health Sciences, Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

¹⁰Rady Faculty of Health Sciences, Department of Anesthesiology, Perioperative Medicine and Pain, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

Abstract

Introduction: Little is known about patterns of opioid prescribing in inflammatory bowel disease (IBD), but pain is common in persons with IBD. We estimated the incidence and prevalence of opioid use in adults with IBD and an unaffected reference cohort and assessed factors that modified opioid use.

Methods: Using population-based health administrative data from Manitoba, Canada, we identified 5233 persons with incident IBD and 26 150 persons without IBD matched 5:1 on sex, birth year, and region from 1997 to 2016. New and prevalent opioid prescription dispensations were quantified, and patterns related to duration of use were identified. Generalized linear models were used to test the association between IBD, psychiatric comorbidity, and opioid use adjusting for sociodemographic characteristics, physical comorbidities, and healthcare use.

Results: Opioids were dispensed to 27% of persons with IBD and to 12.9% of the unaffected reference cohort. The unadjusted crude incidence per 1000 person-years of opioid use was nearly twice as high for the IBD cohort (88.63; 95% CI, 82.73-91.99) vs the reference cohort (45.02; 95% CI, 43.49-45.82; relative risk 1.97; 95% CI, 1.86-2.08). The incidence rate per 1000 person-years was highest in those 18-44 years at diagnosis (98.01; 95% CI, 91.45-104.57). The relative increase in opioid use by persons with IBD compared to reference cohort was lower among persons with psychiatric comorbidity relative to the increased opioid use among persons with IBD and reference cohort without psychiatric comorbidity.

Discussion: The use of opioids is more common in people with IBD than in people without IBD. This does not appear to be driven by psychiatric comorbidity.