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Abstract
Objective Despite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the associated factors and the use of mitigation techniques such as pain-service review and opioid weaning plans among individuals with IBD.
Methods Data were collected from consecutive patients attending IBD outpatient appointments at 12 UK hospitals. A predefined questionnaire was used to collect data including patient demographics, IBD history, opioid use in the past year (>2 weeks) and opioid-use mitigation techniques. Additionally, consecutive IBD-related hospital stays leading up to July 2019 were reviewed with data collected regarding opioid use at admission, discharge and follow-up as well as details of the admission indication.
Results In 1352 outpatients, 12% had used opioids within the past 12 months. Over half of these individuals were taking opioids for non-IBD pain and less than half had undergone an attempted opioid wean.
In 324 hospitalised patients, 27% were prescribed opioids at discharge from hospital. At 12 months postdischarge, 11% were using opioids. Factors associated with opioid use in both cohorts included female sex, Crohn’s disease and previous surgery.
Conclusions 1 in 10 patients with IBD attending outpatient appointments were opioid exposed in the past year while a quarter of inpatients were discharged with opioids, and 11% continued to use opioids 12 months after discharge. IBD services should aim to identify patients exposed to opioids, reduce exposure where possible and facilitate access to alternative pain management approaches.
- INFLAMMATORY BOWEL DISEASE
- ABDOMINAL PAIN
- CLINICAL DECISION MAKING
- ADVERSE DRUG REACTIONS
- IBD SURGERY
Data availability statement
No data are available. Data are protected as recommended by the Caldicott guardian guidance, however, anonymised data relevant to the study have been included in the article or online supplemental information.
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Data availability statement
No data are available. Data are protected as recommended by the Caldicott guardian guidance, however, anonymised data relevant to the study have been included in the article or online supplemental information.
Footnotes
RP and CS are joint senior authors.
Twitter @SamanthaIBD, @DrNickKennedy
Contributors CS and RP designed the study. All authors collected the data. SB performed the analysis. All authors interpreted the results. SB wrote the draft manuscript. All authors critically reviewed the draft manuscript and approved the final manuscript. The guarantor of this article is CS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests SB has had speaker arrangements with Takeda and Dr Falk, has received travel grants from Galapagos, Celltrion and Dr Falk and has provided consultancy to Galapagos. JKL has received grants from Galapagos and Takeda and speaker and consultancy fees from Abbvie, Arena, Celltrion, Ferring, Galapagos, Janssen, MSD, Pfizer and Takeda. GP has had personal fees from AbbVie, Allergan, BMS, Celltrion, Ferring, Galapagos, Janssen, Takeda, Tillotts. Travel grants from—AbbVie, Celltrion, Ferring, Janssen, Takeda, Tillotts and is a Director and Shareholder in Ampersand Health. GS has had speaker arrangements with Takeda, Abbvie, Tillotts and Galapagos. TR has received research/educational grants and/or speaker/consultation fees from Abbvie, Arena, Aslan, AstraZeneca, Boehringer-Ingelheim, BMS, Celgene, Ferring, Galapagos, Gilead, GSK, Heptares, LabGenius, Janssen, Mylan, MSD, Novartis, Pfizer, Roche, Sandoz, Takeda and UCB. CAL reports grants from Genentech, grants and personal fees from Janssen, grants and personal fees from Takeda, grants from AbbVie, personal fees from Ferring, grants from Eli Lilly, grants from Pfizer, grants from Roche, grants from UCB Biopharma, grants from Sanofi Aventis, grants from Biogen IDEC, grants from Orion OYJ, personal fees from Dr Falk Pharma, grants from AstraZeneca, outside the submitted work. NAK has served as a speaker and/or advisory board member for AbbVie, Allergan, BMS, Falk, Ferring, Galapagos, Janssen, Mylan, Pharmacosmos, Sandoz, Takeda and Tillotts. IC has speaker arrangements with Celltrion and has received a travel grant from Galapagos. RP has provided consultancy to Galapagos. CS has received unrestricted research grants from Warner Chilcott, Janssen and AbbVie, has provided consultancy to Warner Chilcott, Dr Falk, AbbVie, Takeda, Fresenius Kabi, Galapagos, Ferring, Arena and Janssen, and had speaker arrangements with Warner Chilcott, Dr Falk, AbbVie, MSD, Pfizer, Celltrion and Takeda.The preparation of this paper was funded in part by Galapagos.
Provenance and peer review Not commissioned; externally peer reviewed.
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