Narcotic use for inflammatory bowel disease and risk factors during hospitalization

Growing evidence demonstrates the adverse effects of narcotics in inflammatory bowel disease (IBD). We sought to study the relationship between narcotic use, objective measures of disease activity, and other associated factors in hospitalized patients with IBD.

We performed a retrospective cohort study of all adult IBD patients admitted to a general medical or surgical ward service at a United States tertiary care center over a 1-year period. We collected demographic and disease-specific information, inpatient narcotic use, and disease activity measurements from endoscopic and radiologic reports. Bivariate comparisons were made between characteristics and narcotic use. Logistic regression was used to evaluate the independent effects of characteristics on narcotic use.

A total of 117 IBD patients were included. Narcotics were given to 70.1% of hospitalized patients. Factors significantly associated with any inpatient narcotic use: Crohn's disease (CD); P ≤ 0.01, duration of IBD, P = 0.02, prior psychiatric diagnosis, P = 0.02, outpatient narcotic use, P ≤ 0.01, current smoking, P ≤ 0.01, prior IBD-specific surgery, P < 0.02, and prior IBD / irritable bowel syndrome (IBS) diagnosis, P = 0.02. Narcotic use was not significantly associated with disease severity on computed tomography (CT) scan or endoscopy. On multivariate analysis, smoking (odds ratio [OR] 4.34, 95% confidence interval [CI] 1.21-15.6) and prior outpatient narcotic use (OR 5.41, 95% CI 1.54-19.0) were independently associated with inpatient narcotic use.

A majority of patients with IBD are prescribed narcotics during hospitalization in spite of data on increased complications. Risk factors for narcotic use include CD and associated factors (disease duration, surgeries), substance abuse (outpatient narcotics and smoking), psychiatric diagnoses, and IBD-IBS.