Opioid Use In IBD Patients
A recent study in the American Journal of Gastroenterology found that opioid use in patients with inflammatory bowel disease (IBD) was associated with higher mortality and greater rates of opioid abuse. This information highlights the importance of close monitoring and compliance with the established medication regimen to prevent flare-ups.
IBD encompasses a group of bowel disorders in which the bowel becomes chronically inflamed, resulting in pain, diarrhea, and other symptoms. Crohn's disease and ulcerative colitis (UC) are both in this category. It is managed with a combination of lifestyle changes and medication. Sometimes, part of the bowel may be removed if damage to the bowel is severe, and patients may live with an ileostomy or colostomy.
The Problem with Opioid Use
The new study followed 4,217 IBD patients for an average of 6.5 years. The study evaluated the use of prescription painkillers for IBD in outpatient settings. 5 percent of the patients in the study became heavy opioid users, taking an equivalent of 50 mg morphine/day or greater for 30 days or longer. There is little evidence that opioids are effective at relieving pain and other symptoms in IBD patients, as these medications temporarily cause pain relief but the cause of pain, i.e. inflammation, is still present and the pain returns. Opioid medications may actually cause worsening of the abdominal pain by causing more intestinal spasms and constipation, in addition to other side effects.
The study revealed poorer outcomes for patients who used opioids heavily. Most notably, heavy opioid use corresponded with non-cancer related mortality in IBD patients. This information is in alignment with other studies on the long-term use of opioids in IBD patients.
Along with opioids, steroids are also associated with increased mortality in IBD patients. Steroids, which reduce inflammation but come with significant side effects, such as decreased immune response, are also commonly prescribed for severe IBD cases.
Preventing Opioid Use
it is ideal to avoid chronic opioid use whenever possible. Opioids are most commonly required during flare-ups of IBD, especially severe flare-ups that put the patient in the hospital or require surgery. The same is true of steroids. Surgery is considered in this setting when medical treatment (or lack of compliance with medical treatment) has failed to control disease.
The best way to avoid chronic opioid and steroid use is to manage the disease as effectively as possible so that severe flare-ups and complications do not occur. This is best achieved with a combination of compliance with the medications to help heal the bowel, along with close monitoring and management by the physician.