Résumé
IntroductionOpioid 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.MethodsData were collected from consecutive patients (Oct 21-Jan 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.ResultsOf 1209 individuals, 52.8% were female, the median age range was 41-45 yrs and 48.1% 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. of these exposures, 63.8% received codeine and 22% strong opioids.The total number of opioid medications that an individual was exposed to was ≥3 in 3.5%, 2 in 11.3% and 1 in 78.7%. Antidepressants, gabapentinoids and/or NSAIDs were co-prescribed in 39.7% of those exposed to opioids. Factors associated with opioid exposure were CD (vs. UC RR 2.69 [95% CI 1.88 -3.86]), previous surgery (RR 2.20 [95% CI 1.62-2.99]), moderate/severe disease activity (vs. remission RR 2.04 [95% CI 1.40-2.97]) and female sex (RR 1.97 [95% CI 1.4-2.7]). Among opioid-exposed patients, 70.2% had comorbidities and ≥ 2 in 14.9% patients. Musculoskeletal (MSK) disease was the most common co-morbidity (53%), of which 31.2% had inflammatory arthritis. MSK related pain was reported as the cause for opioid exposure in 28.4%. In total, 70.2% of opioid-exposed IBD patients underwent objective disease reassessment with endoscopy or cross sectional imaging, with active inflammation found in 41.8%. Pain services reviewed 27% of opioid-exposed patients, of which 42.9% received ≥ 2 opioid medications.ConclusionIn an analysis of unselected IBD patients attending clinic, 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 female sex, previous surgery. 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.