Targownik Laura E, Nugent Zoann, Singh Harminder, Bugden Shawn, Bernstein Charles N
1] Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada [2] University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
1] Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada [2] CancerCare Manitoba, Winnipeg, Manitoba, Canada.
Am J Gastroenterol. 2014 Oct;109(10):1613-20. doi: 10.1038/ajg.2014.230. Epub 2014 Sep 2.
Opioids are commonly used in the treatment of pain and associated symptoms of inflammatory bowel disease (IBD). The continuous use of opioids has been associated with adverse outcomes, including death. The prevalence and the risk factors for opioid use in IBD are poorly characterized.
We used the population-based Manitoba IBD Epidemiology Database to identify all individuals in Manitoba with IBD who were prescribed opioids both before and following diagnosis. We determined the point prevalence of any opioid use, as well as the risk of becoming a heavy opioid user (defined as continuous use for 30 days at a dose exceeding 50 mg morphine/day or equivalent). Logistic regression and Cox proportional hazards models were generated to assess whether IBD was an independent risk factor for opioid use, the risk factors for opioid use in individuals with IBD, and to determine whether opioid use was associated with excess mortality in IBD.
Within 10 years of diagnosis, 5% of individuals with IBD had become heavy opioid users. Moderate use of opioids before diagnosis was strongly predictive of future heavy use. Individuals with IBD were significantly more likely to become heavy opioid users than their matched controls (odds ratio (OR) 2.91, 95% confidence interval (CI) 2.19-3.85). Heavy opioid use was strongly associated with mortality (OR 2.82, 95% CI 1.58-5.02).
IBD is an independent risk factor for becoming a heavy opioid user, and heavy opioid use is associated with excess mortality in IBD patients. Clinicians should recognize risk factors for future heavy opioid use among their patients with IBD.
阿片类药物常用于治疗炎症性肠病（IBD）的疼痛及相关症状。持续使用阿片类药物与不良后果相关，包括死亡。IBD患者中阿片类药物使用的患病率及危险因素尚不明确。
我们利用基于人群的曼尼托巴省IBD流行病学数据库，识别出曼尼托巴省所有在诊断前后均开具阿片类药物处方的IBD患者。我们确定了任何阿片类药物使用的时点患病率，以及成为阿片类药物重度使用者（定义为以超过50毫克吗啡/天或等效剂量持续使用30天）的风险。生成逻辑回归和Cox比例风险模型，以评估IBD是否为阿片类药物使用的独立危险因素、IBD患者中阿片类药物使用的危险因素，并确定阿片类药物使用是否与IBD患者的额外死亡率相关。
在诊断后的10年内，5%的IBD患者成为阿片类药物重度使用者。诊断前适度使用阿片类药物强烈预示着未来会重度使用。IBD患者比匹配的对照组更有可能成为阿片类药物重度使用者（优势比（OR）2.91，95%置信区间（CI）2.19 - 3.85）。阿片类药物重度使用与死亡率密切相关（OR 2.82，95% CI 1.58 - 5.02）。
IBD是成为阿片类药物重度使用者的独立危险因素，且阿片类药物重度使用与IBD患者的额外死亡率相关。临床医生应认识到IBD患者未来阿片类药物重度使用的危险因素。
