Opioid Use and Outcomes in Patients Hospitalized With Acute Severe Ulcerative Colitis

Area of Science:

• Gastroenterology
• Clinical Pharmacology
• Health Services Research

Background:

• Opioid use in hospitalized inflammatory bowel disease patients has not been proven to improve pain or reduce length of stay.
• The impact of high-dose opioid use on clinical outcomes in acute severe ulcerative colitis (ASUC) remains underexplored.

Purpose of the Study:

• To investigate the association between high opioid use and clinical outcomes in patients hospitalized with ASUC.
• To determine if high opioid consumption influences biologic rescue therapy initiation, colectomy rates, or hospital stay.

Main Methods:

• A single-center study analyzed 185 ASUC hospitalizations (July 2014-December 2021) receiving intravenous corticosteroids.
• Data collected included opioid exposure (≥40 oral morphine equivalents/day defined as high use), corticosteroid dose, biologic therapy, colectomy, discharge opioids, length of stay, and cost.
• Univariable logistic regression assessed the relationship between high opioid use and ASUC outcomes.

Main Results:

• High opioid use (≥40 OMEs/day) was observed in 11% of patients and was linked to a median 3-day delay in initiating biologic rescue therapy (P=.02).
• Patients with high opioid use had significantly higher rates of receiving opioid prescriptions at discharge (70% vs. 10%, P<.001).
• No significant association was found between high opioid use and length of stay, corticosteroid duration, colectomy rate, or hospitalization cost.

Conclusions:

• In ASUC hospitalizations, high opioid use is associated with delayed initiation of crucial biologic rescue therapies.
• High opioid consumption correlates with an increased likelihood of patients being discharged with opioid prescriptions.
• These findings highlight potential risks of high opioid utilization in ASUC management.