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Published on: September 22, 2019
Prevalence of chronic narcotic use among children with inflammatory bowel disease
Jessie P Buckley1, Suzanne F Cook2, Jeffery K Allen2
1Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, Chapel Hill, North Carolina.
Insights
Children with inflammatory bowel disease (IBD) are more likely to use narcotics chronically than the general population. Psychological impairment significantly increases this risk, highlighting the need for integrated mental health care.
Area of Science:
- Pediatric Gastroenterology
- Pain Management
- Psychiatry
Background:
- Narcotic analgesics are not recommended for long-term pain management in pediatric inflammatory bowel disease (IBD).
- Chronic narcotic use in children with IBD and the general population requires investigation.
- Factors associated with narcotic use in pediatric IBD patients need to be identified.
Purpose of the Study:
- To compare the prevalence of chronic narcotic use in children with IBD versus the general pediatric population.
- To identify factors associated with chronic narcotic use in pediatric IBD patients.
Main Methods:
- A cross-sectional study analyzed a large administrative claims database (2010-2011) of 4,911,286 children.
- Children with IBD (n=4344) were matched with controls (n=21,720).
- Chronic narcotic use was defined as ≥3 dispensements; logistic regression analyzed associations.
Main Results:
- The prevalence of chronic narcotic use was higher in children with IBD (5.6%) compared to the general population (2.3%).
- Pediatric IBD patients with psychological impairment had a significantly higher odds ratio for chronic narcotic use (POR=6.8) than those without (POR=2.3).
- Older age, increased healthcare utilization, fractures, and psychological impairment were associated with chronic narcotic use in pediatric IBD.
Conclusions:
- Chronic narcotic use is prevalent in pediatric IBD patients, especially those with anxiety and depression.
- Psychological comorbidities are strongly linked to narcotic use in this population.
- Increased awareness, screening, and treatment of psychological comorbidities may reduce narcotic use and its complications.
Background & Aims:
Narcotic analgesics are not recommended for long-term management of pain for patients with inflammatory bowel disease (IBD), particularly pediatric patients. We compared chronic use of narcotics among children with IBD and the general population and investigated factors associated with narcotic use in the pediatric IBD population.
Methods:
This cross-sectional study included children (younger than 18 years old) with continuous enrollment in a large administrative claims database from 2010 through 2011 (n = 4,911,286). Children with IBD were identified through diagnosis codes and dispensation of IBD medication (n = 4344); they were matched for age, sex, and region with 5 children without IBD (n = 21,720). Chronic narcotic use was defined as ≥3 dispensements of narcotics. We estimated prevalence odds ratios (PORs) and 95% confidence intervals (CIs), comparing narcotic use on the basis of IBD status and evaluating variables associated with narcotic use by patients with IBD by using conditional and unconditional logistic regression.
Results:
The prevalence of chronic narcotic use was 5.6% among children with IBD vs 2.3% in the general population (POR, 2.6; 95% CI, 2.2-3.0). Compared with the general population, POR for chronic narcotic use was significantly higher for pediatric IBD patients with psychological impairment (POR, 6.8; 95% CI, 4.3-10.6) than those without (POR, 2.3; 95% CI, 1.9-2.7). Older age, increased healthcare utilization, fracture, and psychological impairment were strongly associated with chronic use of narcotics among children with IBD.
Conclusions:
Chronic narcotic use is common in pediatric IBD patients, particularly among those with anxiety and depression. Increased awareness of psychological comorbidity, screening, and treatment may reduce symptoms that lead to narcotic use and its complications.
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