Predictors for chronic opioid use in patients with inflammatory bowel disease - a population based cohort study

Background:A significant proportion of patients with Crohn's disease (CD) and ulcerative colitis (UC) become opioid users, but data pertaining to predictors of chronic opioid use remain sparse.Objective:We examined predictors for chronic opioid use in CD/UC.Design:A nationwide cohort study based on Danish registries, comprising incident patients with CD/UC (≥ 18 years) from January 1, 1996-December 31, 2021. Chronic opioid use was defined as >1 prescriptions in at least two of three consecutive quarters. Cox regression models were used to estimate adjusted Hazard Ratios (aHRs) for predictors for chronic opioid use. Several variables and time-varying covariates (IBD surgery, IBD and psychotropic medications) were included.Results:In 15,092 CD patients, 4,141 (27.4%) became chronic opioid users (median follow up 7.35 years, 25%-75% percentiles (IQR) 3.40-13.66 years). The three most important predictors were surgery (4.20, 95% CI 3.72-4.75), hypnotics/sedatives (2.02, 95% CI 1.81-2.25), and age > 50 years (1.92, 95% CI 1.77-2.09). In 30,416 UC patients, 6,777 (22.3%) became chronic users (median follow up 8.80 years, IQR 4.20-15.22 years). The three most important predictors were surgery (4.81, 95% CI 4.20-5.52), age > 50 years (2.62 (95% CI 2.44-2.82), and hypnotics/sedatives (2.11, 95% CI 1.95-2.29).Conclusion:An alarming proportion of patients became chronic opioid users. These results are helpful to risk-stratify patients to prevent chronic opioid use. Clinicians should be particularly attentive in patients who have had surgery, who use hypnotics/sedatives, and who are elderly. We need evidence regarding pain management strategies, efficacy of non-opioid analgesics, and opioid cessation strategies.