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

Aims: 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. Methods: 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. Results: 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). Conclusions: 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).