Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Jan 21, 2019; 10(1): 22-28
Published online Jan 21, 2019. doi: 10.4292/wjgpt.v10.i1.22
Opioid use and misuse in ulcerative colitis
Maithili V Chitnavis, Merwise Baray, Patrick G Northup, Anne G Tuskey, Brian W Behm
Maithili V Chitnavis, Division of Gastroenterology and Hepatology, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, United States
Merwise Baray, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
Patrick G Northup, Anne G Tuskey, Brian W Behm, Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
Author contributions: All authors helped to perform the research; Chitnavis MV performed data analysis, drafting conception and design, and writing the manuscript; Baray M and Tuskey AG helped in data collection; Northup PG performed data and statistical analysis; Behm BW performed drafting conception and study design, data analysis, and writing the manuscript.
Institutional review board statement: This study was reviewed and approved by the University of Virginia Institutional Review Board for Health Sciences Research (IRB-HSR).
Informed consent statement: Patients were not required to give informed consent for this study as the analysis was conducted retrospectively and no identifying factors were used in the analysis.
Conflict-of-interest statement: The authors declare no potential conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Maithili V Chitnavis, MD, Assistant Professor, Division of Gastroenterology, Virginia Tech Carilion School of Medicine, 3 Riverside Circle, Roanoke, VA 24016, United States. mvchitnavis@carilionclinic.org
Telephone: +1-540-224-5170 Fax: +1-540-9838242
Received: October 19, 2018
Peer-review started: October 19, 2018
First decision: November 15, 2018
Revised: December 24, 2018
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: January 21, 2019
Processing time: 94 Days and 14.7 Hours
Abstract
BACKGROUND

Patients with ulcerative colitis (UC) may be exposed to opioids over their disease duration. The use of such medications carries significant risk, including intestinal dysmotility and potential for addiction. However, the rates of narcotic use and misuse in patients with UC have not been studied extensively. Functional gastrointestinal disorders (FGID) are prevalent in patients with UC, and have been shown to increase the risk of narcotic use and misuse in patients with Crohn’s disease. We hypothesized that patients with UC and a concurrent diagnosis of FGID would have increased rates of both opioid use and misuse in our patient cohort.

AIM

To evaluate the prevalence of chronic opioid use and misuse in UC.

METHODS

A retrospective chart review of UC patients seen at the University of Virginia Digestive Health Center was performed on all patients evaluated between 2006 and 2011. Patient demographics, medical, surgical, and medication histories were obtained from the electronic medical record. Concomitant diagnosis of FGID was also noted at the time. The electronic prescription monitoring program was accessed to obtain prescription opioid filling histories. Prescription opioid misuse was defined as opioid prescriptions filled from four or more prescribers and four or more different pharmacies in a 12-mo period.

RESULTS

A total of 497 patients with UC were included. Patients with UC and FGID were more likely to be female, but no other demographic variables were associated with FGID. Of the UC patients who had FGID, a greater proportion were found to be using opioids chronically (36% with FGID vs 9% without FGID, P < 0.0001) and were misusing prescription opioids (12.8% vs 1.3%, P < 0.001). Multivariate logistic regression demonstrated a significant association with FGID and chronic opioid use (OR = 4.50; 95%CI: 1.91-10.59) and opioid misuse (OR = 5.19; 95%CI 1.04-25.76). Tobacco use (OR 2.53; 95%CI: 1.06-6.08) and anxiety (OR 3.17; 95%CI: 1.08-9.26) were other variables associated with an increased risk of chronic narcotic use.

CONCLUSION

FGID was associated with a 4.5-fold increase in chronic opioid use and a 5-fold increased risk of opioid misuse in this patient cohort with UC.

Keywords: Ulcerative colitis; Chronic opioid use; Opioid misuse; Narcotic; Functional gastrointestinal disorder

Core tip: Rates of chronic opioid use and misuse among patients with ulcerative colitis (UC) have not been studied extensively, and it is unknown whether functional gastrointestinal disorder (FGID) affects these rates. The aims of this study were to evaluate rates of opioid use and misuse in UC and determine whether these rates were affected by concomitant FGID. Patients with FGID and UC were 4.5 times more likely to be using chronic opioids and 5 times more likely to be misusing opioids. This highlights the potential risks of opioid use in the management of UC, particularly in those patients with concomitant FGID.