Heavy Use of Strong Opioids Leads to More IBD Patients Dying Early, Study Finds

Heavy Use of Strong Opioids Leads to More IBD Patients Dying Early, Study Finds

Heavy use of strong opioid pain medication has led to an increase in early deaths among inflammatory bowel disease patients, a British study reports.

The research dealt with early deaths from all causes, not just from IBD.

Researchers published the study, “Increasing Prescription of Opiates and Mortality in Patients With Inflammatory Bowel Diseases in England,” in Clinical Gastroenterology and Hepatology.

Many IBD patients take opioids for pain. Unfortunately, the medications can cause a number of gastrointestinal tract problems.

The number of opioid prescriptions that doctors write for both cancer and non-cancer pain has jumped in the past decade. One British study showed a doubling of prescriptions for weak opioids and a six-fold increase in prescriptions for strong opioids between 2005 and 2012.

Complications from increased opioid use include more psychosocial problems, more hospitalizations and higher early death rates.

Little information has been available on the opioid prescription trend in IBD patients and on the trend’s connection with early death rates, however. British researchers decided to study the issue.

They looked at the medical records of 3,517 people with Crohn’s disease and 5,349 with ulcerative colitis in England to identify trends in opioid use overall and by category of drug between 1990 and 2014. The categories included codeine, tramadol and strong opioids.

The team found a statistically significant increase in opioid prescriptions. Between 1990 and 1993, doctors wrote opioid prescriptions for only 10 percent of IBD patients. The figure tripled to 30 percent between 2010 and 2013.

Researchers also looked for links between increases in opioid prescriptions and more patients dying early. They discovered a rise in early deaths among Crohn’s patients who made heavy use of opioids — that is, who had more than three prescriptions a year.

They also found more early deaths among ulcerative colitis patients who made either heavy or moderate use of opioids. They defined moderate as one to three prescriptions a year.

In addition, the team discovered that ulcerative colitis patients who made heavy use of codeine were at higher risk of dying early. They did not find an increase in early deaths among either Crohn’s or colitis patients who took tramadol by itself or combined with codeine.

Their key conclusions were that prescriptions for opioids medications increased significantly between 1990 and 2013 and that there was link between heavy use of opioids and more patients dying early.

Because other research has shown connections between increased opioid use and higher disease and death rates, the researchers noted that some medical jurisdictions have come up with “guidelines to limit opiate use.”

“We believe that there should be the same pharmacovigilance applied to prescribing opiates for those with IBD” as with other conditions, especially because heavy use is “associated with the worst outcomes,” the team concluded.