Opioid Use Among Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Blake Niccum; Oluwatoba Moninuola; Kaia Miller; Hamed Khalili

doi:10.1016/j.cgh.2020.08.041

Opioid Use Among Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Clin Gastroenterol Hepatol. 2021 May;19(5):895-907.e4. doi: 10.1016/j.cgh.2020.08.041. Epub 2020 Aug 21.

Authors

Blake Niccum¹, Oluwatoba Moninuola², Kaia Miller³, Hamed Khalili⁴

Affiliations

¹ Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
² Department of Internal Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
³ Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
⁴ Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts; Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. Electronic address: hkhalili@mgh.harvard.edu.

PMID: 32835841
DOI: 10.1016/j.cgh.2020.08.041

Abstract

Background and aims: Despite reported adverse effects of opioids in patients with inflammatory bowel disease (IBD), the burden of opioid use in this population appears to be high. We performed a systematic review and meta-analysis of prior studies to determine the prevalence of opioid use among patients with IBD as well as risk factors and outcomes associated with opioid use in this population.

Methods: We conducted a systematic search of MEDLINE, Embase, Web of Science, and the Cochrane Library through November of 2019. Primary outcomes included the prevalence of opioid use and demographic and clinical variables associated with opioid use in patients with IBD. Quality was assessed using the Newcastle-Ottawa scale. We used random-effect meta-analysis to estimate pooled relative risks (RRs) and 95% CIs.

Results: Of 780 citations identified, 31 were included in our study. The prevalence of opioid use was 21% (95% CI, 13%-30%) in the outpatient setting. Likewise, 62% (95% CI, 25%-92%) of patients received opioids while hospitalized for IBD. Opioid use was associated with female sex (RR 1.20; 95% CI 1.03-1.40), depression (1.99; 95% CI 1.80-2.19), substance abuse (4.67; 95% CI 2.87-7.60), prior gastrointestinal surgery (2.33; 95% CI 1.66-3.26), biologic use (1.36; 95% CI 1.06-1.74), and steroid use (1.41; 95% CI 1.04-1.91). Based on the systematic review, opioid use also appeared to be associated with increased IBD activity, healthcare use, infection, and mortality.

Conclusion: In a systematic review and meta-analysis, we found that 21% of outpatients with IBD (and 62% of hospitalized patients) are opioid users; use is associated with more severe IBD and increased healthcare use. Further studies are required to determine whether opioids are the cause or an effect of these associations. Nonetheless, urgent interventions are needed to reduce opioid use, improve disease-related outcomes and reduce healthcare costs.

Keywords: Crohn’s Disease; Inflammatory Bowel Disease; Narcotics; Opiates; Opioids; Ulcerative Colitis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Analgesics, Opioid / adverse effects
Colitis*
Female
Humans
Inflammatory Bowel Diseases* / drug therapy
Inflammatory Bowel Diseases* / epidemiology
Prevalence
Risk Factors

Substances

Analgesics, Opioid