Opioids after IBD hospitalization tied to worse outcomes
Patients with inflammatory bowel disease (IBD) who filled an opioid prescription within seven days of a hospital or ED visit were more likely to come back to the hospital, to receive a corticosteroid prescription, or to have an escalation of medical therapy.
Patients who are prescribed opioids after a hospital or ED stay for inflammatory bowel disease (IBD) are more likely to be readmitted and are prescribed more medications, a study found.
The retrospective study used a claims database to identify 35,890 IBD patients who had a hospital or ED visit in 2017 to 2021 (mean age, 42.4 years, 54.9% women); 7,892 of the patients (22%) received an opioid prescription within seven days of discharge. Demographics, baseline clinical features, and clinical outcomes were compared between patients who did and did not get opioids within seven days. Results were published by the Journal of Clinical Gastroenterology on Nov. 5.
The most commonly prescribed opioids were hydrocodone (39.6%), oxycodone (36.8%), and tramadol (13.6%). Almost all prescriptions (95.2%) were for seven days or fewer. The opioid-receiving patients had a higher mean age and were more likely to be female, but patient characteristics were generally similar otherwise. The study did find a decreasing rate of opioid prescriptions over the analyzed time period.
Within a month after discharge, patients who filled an opioid prescription had a significantly increased risk of visiting the ED (odds ratio [OR], 1.27 [95% CI, 1.15 to 1.40]; P<0.001) or being hospitalized (OR, 1.33 [95% CI, 1.17 to 1.53]; P<0.001). They were also more likely to receive a corticosteroid prescription at one month (OR, 1.11 [95% CI, 1.02 to 1.20]; P=0.015) or at six months (OR, 1.09 [95% CI, 1.03 to 1.15]; P=0.005), as well as to get an opioid prescription at one, three, or six months (ORs, 4.25 [95% CI, 3.88 to 4.66], 2.71 [95% CI, 2.53 to 2.90], and 2.31 [95% CI, 2.18 to 2.46], respectively, P<0.001 for all compared to those who did not get opioids after discharge). They also had more likelihood of IBD-associated medication escalation by six months (OR, 1.11 [95% CI, 1.02 to 1.21]; P=0.013)
The study authors said that they believe this to be the first study “to specifically evaluate clinical outcomes in IBD patients being prescribed opioids on discharge from acute care settings” and that it demonstrated that such prescriptions are associated with several negative outcomes, including repeat hospitalizations and ED visits, subsequent opioid use, corticosteroid use, and escalation of medical therapy. The results “highlight the serious adverse effects associated with opioid use in IBD patients” and should encourage clinicians to “limit prescribing opioids to individuals with IBD as much as possible in this setting,” the authors said.