The persistence of chronic opioid use in patients with inflammatory bowel disease-A nationwide cohort study

Pain is common in patients with Crohn's disease (CD) and ulcerative colitis (UC), and a substantial proportion develop chronic opioid use (COU). We examined the persistence of COU over time and identified factors predicting persistent use.

This nationwide Danish cohort study included patients with an initial period of COU (definition: ≥3 opioid prescriptions within 12 months with at least 30 days between prescriptions). We examined persistent COU for 2 years thereafter. Predictors for persistent COU were examined in multivariable logistic regression analyses.

Among 6208 patients with COU, 49.6% had persistent COU in the first follow-up year: 30.4% with only weak opioids, 11.7% with weak/strong opioids and 7.5% with only strong opioids. In the second follow-up year, two-thirds of those with persistent COU remained chronic users. Among 2553 patients with CD, key predictors of persistent COU in the first year of follow-up were age ≥70 years at disease onset (adjusted odds ratio [aOR] = 1.73, 95% CI: 1.22-2.45) and antidepressant use (aOR = 1.44, 95% CI: 1.18-1.75). Among the 3655 patients with UC, predictors included high comorbidity (aOR = 1.45, 95% CI: 1.05-2.00), age ≥70 years (aOR = 1.41, 95% CI: 1.09-1.82) and anxiolytic use (aOR = 1.38, 95% CI: 1.12-1.71).

After an initial period of COU, half of all patients had persistent COU after 1 year, and among these two-thirds still had COU after an additional year. The main predictors of persistent COU were factors related to vulnerability (advanced age and mental health conditions).