High-Dose Opioid Use Among Adolescents and Young Adults with Chronic Digestive Disorders

High-dose opioid use (≥ 50 morphine milligram equivalents [MME]/day) is associated with increased risk of adverse outcomes, including overdose. We investigated the prevalence and risk factors for high-dose opioid use among adolescents and young adults (AYA) with inflammatory bowel disease (IBD) and other chronic digestive disorders to inform safer pain management strategies.

This retrospective cohort study identified AYA aged 15-29 years with chronic digestive disorders who received ≥ 1 outpatient opioid prescription between March 2018 and December 2021, using Northwestern Medicine's Electronic Data Warehouse. Short-term persistent high-dose opioid use was defined as a daily mean of ≥ 50 MME/day for ≥ 7 consecutive days. Patients were categorized into high-dose vs. non-high-dose users. We examined demographic and clinical covariates (e.g., race/ethnicity, insurance status, psychiatric diagnoses, GI and non-GI pain diagnoses, concurrent medications) using descriptive and bivariate analyses. Risk factors for high-dose use were identified via multivariate logistic regression.

Among 2549 AYA patients, 12% met criteria for high-dose opioid use. Risk factors included older age within the cohort, benzodiazepine-opioid co-use, oxycodone use, and concurrent non-GI pain diagnoses (e.g., arthritis).

Nearly 12% of AYA with chronic digestive disorders who used opioids for ≥ 7 days received high-dose prescriptions. These findings underscore the need for safer prescribing guidelines tailored to this population. Future work should consider weight-based dosing thresholds and expanded datasets to monitor and reduce opioid-related harm in AYA with digestive disorders.