Opioids linked to mortality in IBD

Balancing control of pain and prevention of opioid-related morbidity and mortality remains a major challenge for health care providers, particularly in IBD. This study by Burr et al. highlights the potential dangers of opiate use among patients with IBD with the finding that opioid prescriptions at least three times per year were associated with a two- to threefold increase in mortality. Another important observation from this study was that the prevalence of opioid use among IBD patients increased from 10% to 30% during 1990-2013. One would like to believe that, with better treatment modalities for IBD, fewer patients would require chronic opioid medications over time; however, this observation suggests that there has been a shift in the perception and acceptance of opioids for IBD patients.

Studying opioid use among IBD patients remains challenging as even well-controlled retrospective studies are unable to fully separate whether opioid use is merely associated with more aggressive IBD courses and hence worse outcomes, or whether opioid use directly results in increased mortality. As clinicians, we are left with the difficult balance of addressing true symptoms of pain with the potential harm from opioids; we often counsel against the use of nonsteroidal anti-inflammatory medications in IBD, and yet there is growing concern about use of opioids in this same population. Further research is needed to address patients with pain not directly tied to inflammation or complications of IBD, as well as nonmedical, behavioral approaches to pain management.

Dr. Jason K. Hou