P0490 Opioid exposure in IBD and associated factors: a UK prospective multicentre audit of 1362 patients

Published Date: 09th October 2022

Publication Authors: Bassi A

Introduction
Opioid exposure in inflammatory bowel disease (IBD) is associated with premature mortality, yet exposure in IBD increasing. International guidelines have been introduced to rationalise opioid use. While opioids may improve acute pain, long term exposure is rarely beneficial and is associated with side effects.We conducted a multicentre audit aiming to evaluate opioid use and associated factors in patients with IBD.

Aims & Methods
Data were collected from consecutive patients (Oct 21-Mar 22) attending IBD clinics at 12 hospitals across most regions of the UK. Opioid exposure (>2 weeks in the past 12 months), associated factors and concurrent medical management were assessed and analysed.

Results
Of 1362 individuals, 53.0% were female, the median age range was 41-45 yrs and 47.8% had Crohn’s disease (CD). Opioid exposure occurred in 11.7% of individuals with 5.0% of the overall cohort reporting IBD as the indication. In the whole cohort 7.8% received codeine and 3.5% strong opioids. Within the opioid exposed group the total number of opioid medications that an individual received was ≥3 in 3.3%, 2 in 11.2% and 1 in 85.5%. Antidepressants, gabapentinoids and/or NSAIDs were co-prescribed in 39.7% of those exposed to opioids.

In the opioid exposed group 43% of patients believed they were taking opioids primarily for IBD. Of these 30.8% did not have an objective disease assessment with imaging or colonoscopy in preceding year. Those with objective assessment had evidence of active inflammation in 72.3%, evidence of scarring/adhesions in 17.0% and no evidence of either in 10.6%. Among opioid-exposed patients, 65.8% had comorbidities and ≥ 2 in 15.5% patients. Musculoskeletal (MSK) disease was the most common co-morbidity (62.5%), of which 31.2% had inflammatory arthritis.

Factors associated with opioid exposure on multivariable regression analysis were previous surgery (RR 2.56 [95% CI 1.75-3.74]), while UC (versus CD RR 0.45 [95%CI 0.30-0.67]) and male sex (versus female RR 0.45 [95% CI 0.32-0.65]) were associated with less opioid exposure. Age and disease duration were not associated with opioid exposure.

Pain services reviewed 25% of opioid-exposed patients. We observed significant variations by site with referral rates to pain services ranging from none to 100%. Opioid weaning was attempted in 43% of cases only.

Conclusion
In an analysis of unselected IBD patients attending clinic, just over one tenth had been exposed to opioids in the past year. Co-existent MSK co-morbidities were common, other factors associated with opioid exposure included a diagnosis of CD, female sex, previous surgery. Referral to pain services varied between sites and opioid weaning was attempted in less than half of cases. IBD services should aim to identify patients at risk of opioid exposure, reducing exposure when possible and help to access alternative and more effective pain management solutions.

 

Baillie, S; Bassi, A et al. (2022). P0490 Opioid exposure in IBD and associated factors: a UK prospective multicentre audit of 1362 patients. United European Gastroenterology Journal. 10(Suppl 8), pp.788-789. [Online]. Available at: https://onlinelibrary.wiley.com/doi/10.1002/ueg2.12295 [Accessed 3 February 2023]

 

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