Mo1780 - The Impact of Chronic Opioid use on IBD Healthcare Utilization

Background: Opioid analgesics are frequently used to manage chronic abdominal pain in inflammatory bowel disease (IBD). Large, nationwide studies have described the prevalence of chronic opioid use (COU) to be approximately 4-7% among Crohn's patients and have associated COU with considerable risks, including death. However, the prevalence of opioid use within an outpatient IBD clinic population is not well described. We sought to quantify opioid use within the IBD clinic at the University of Kentucky and describe the impact it has on healthcare utilization and disease course. Method(s): We retrospectively reviewed all patients seen in the outpatient IBD clinic that had received at least one outpatient opioid analgesic prescription over a period of 34 months. Data was obtained from a review of the Kentucky prescription drug monitoring system reports (KASPER). COU was defined as having at least 90 days of opioid supply within a 6 month period without any 30 day gaps. We collected data on biologic use, steroid courses, emergency department (ED) visits, readmissions, surgeries, radiologic (CT or MRI) utilization and calculated composite utilization scores. Result(s): A total of 740 distinct patients were seen in the IBD clinic over the follow up period. Of them, 23.8% were prescribed opioids at least once and 10.1% fulfilled the definition of COU. We retrospectively analyzed the charts of 101 patients that were prescribed opioids at least once. The mean number of opioid prescriptions per patient was 18.4 +/- 20. Patients who were on chronic opioids were significantly more likely to obtain opioids from >=4 prescribers and pharmacies (p= 0.0003) and be diagnosed with psychiatric disease (0.0095) than patients who were not chronic users. Furthermore, patients who were chronic users had more than double the average number of ED visits (3.8 vs. 1.4, p=0.0125), CT or MRI scans (4.0 vs. 1.5, p= 0.0007) and a higher composite utilization scores (23.9 vs. 14.5, p= 0.041) than patients who were not chronic users. Conclusion(s): The rate of chronic opioid use among our IBD clinic patients is alarmingly high. Patients on chronic opioids are more likely to obtain analgesics from several different providers and pharmacies, be diagnosed with psychiatric disease. Providers should be aware of these red flags when prescribing long term analgesics in the clinic. Patients with COU had more than double the number of ED visits and CT/MRI scans compared to non-chronic users. This raises concern of discontinuity of care and high radiation exposure. In the future, we suggest involving addiction and pain specialists in the IBD clinic to minimize COU. This is supported by the high risk for chronic and heavy use of opioids exhibited by this population and the need to offer alternative options for analgesia.Copyright © 2018 AGA Institute. All rights reserved.