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Predictors of Chronic Opioid Use in Newly Diagnosed Crohn's Disease
Nathan J Pauly1, Lamprinos Michailidis, Michael G Kindred
1*University of Kentucky College of Pharmacy, Institute for Pharmaceutical Outcomes and Policy, Lexington, Kentucky; †University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, Kentucky; ‡University of Kentucky College of Medicine, Department of Psychiatry, Lexington, Kentucky; §University of Kentucky College of Medicine, Department of Digestive Diseases and Nutrition, Lexington, Kentucky; and ‖University of Kentucky, Center on Drugs and Alcohol Research, Lexington, Kentucky.
Background And Aims:
Patients with Crohn's disease (CD) are often prescribed opioids chronically to manage pain associated with their disease. However, little evidence exists to support this practice. Here, we examine newly diagnosed patients with CD with and without chronic opioid use (COU) and sought to identify predictors and consequences of COU.
Methods:
A nationally representative administrative health care claims that data set identified newly diagnosed patients with CD. Their data were examined during the periods 6 months before and 2 years after diagnosis. Multivariable logistic regression was used to assess predictors of COU at diagnosis.
Results:
The final study cohort consisted of 47,164 patients with CD. Of them, 3.8% were identified with new COU. Chronic opioid users were more likely women, older, and likely who had more surgeries, endoscopies, admissions, and medication usage compared with other patients. Features detected before CD diagnosis that correlated with COU after diagnosis included previous opioid use (odds ratio [OR] = 6.6), chronic pain (OR = 1.36), arthritis (OR = 1.95), and mental disorders (OR = 1.58). Interestingly, emergency department visits before CD Dx increased the risk of COU (OR = 1.11), whereas endoscopy reduced COU risk (OR = 0.88).
Conclusions:
This study presents a nationally representative assessment of COU in newly diagnosed patients with CD. The results may be used to determine the impact of COU in this population and to alert clinicians to those patients with CD at high risk of COU. Chronic opioids are consistently associated with indicators of more severe disease; however, additional research is needed to determine whether COU drives disease severity or vice versa.