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

1 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.

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

3 Center for Health Care Innovation, University of Pennsylvania.

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

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

6 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.