Abstract

Exposure to Intravenous Opioids is Associated With Future Exposure to Opioids in Hospitalized Patients With Inflammatory Bowel Diseases

Dalal RS1, Palchaudhuri S2, Snider CK3, Lewis JD4, Mehta SJ5, Lichtenstein GR6. Clin Gastroenterol Hepatol. 2019 Dec 27. pii: S1542-3565(19)31504-6. doi: 10.1016/j.cgh.2019.12.024. [Epub ahead of print]

 
     

Author information

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Center for Health Care Innovation, University of Pennsylvania.

Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania.

Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Center for Health Care Innovation, University of Pennsylvania.

Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: Gary.Lichtenstein@uphs.upenn.edu.

Abstract

BACKGROUND & AIMS: Opioid use is associated with increased mortality in patients with inflammatory bowel diseases(IBD). Hospitalized patients with IBD often receive high-potency intravenous opioids (IVOPIs). It is not known whether exposure to IVOPIs affects post-discharge opioid use or complications. We investigated the association between inpatient administration of IVOPIs and a post-discharge opioid prescription (OPIRx) in patients with IBD.

METHODS: We performed a retrospective cohort study of 862 adults with IBD hospitalized at a large urban academic health system from March 1, 2017 through April 10, 2018. We collected clinical data from the electronic health records and used multivariable mixed-effect logistic regression to assess the association between inpatient opioid exposure and OPIRx within 12 months while adjusting for confounders. IV and non-IVOPI exposures were evaluated as binary variables. IVOPI exposure was also evaluated as a continuous variable in IV morphine mg equivalents/length of stay (IVMMEs/day).

RESULTS: Multivariable mixed-effect logistic regression demonstrated a significant association between IVOPIs and OPIRx (IV vs no IVOPIs odds ratio [OR], 3.3; 95% CI, 1.7-6.4 and IVMMEs/day OR, 1.1; 95% CI, 1.0-1.1). Subgroup analysis of patients with IBD flares (n=621) identified a significant association between IVOPIs and OPIRx (IV vs no IVOPIs OR, 5.4; 95% CI, 2.6-11.0). Among patients who did not receive IVOPIs, there was a significant association between oral/transdermal opioids and OPIRx (non-IVOPIs vs no opioids OR, 4.2; 95% CI, 1.0-16.8).

CONCLUSIONS: Inpatient IV and non-IV opioid use are associated with post-discharge opioid exposure in patients with IBD, with a dose-dependent effect. Alternative analgesics should be considered for hospitalized patients with IBD, to minimize risk of future opioid use.

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