溃疡性结肠炎中阿片类药物的使用与滥用
Opioid use and misuse in ulcerative colitis.
作者信息
Chitnavis Maithili V, Baray Merwise, Northup Patrick G, Tuskey Anne G, Behm Brian W
机构信息
Division of Gastroenterology and Hepatology, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, United States.
University of Virginia School of Medicine, Charlottesville, VA 22908, United States.
出版信息
World J Gastrointest Pharmacol Ther. 2019 Jan 21;10(1):22-28. doi: 10.4292/wjgpt.v10.i1.22.
BACKGROUND
Patients with ulcerative colitis (UC) may be exposed to opioids over their disease duration. The use of such medications carries significant risk, including intestinal dysmotility and potential for addiction. However, the rates of narcotic use and misuse in patients with UC have not been studied extensively. Functional gastrointestinal disorders (FGID) are prevalent in patients with UC, and have been shown to increase the risk of narcotic use and misuse in patients with Crohn's disease. We hypothesized that patients with UC and a concurrent diagnosis of FGID would have increased rates of both opioid use and misuse in our patient cohort.
AIM
To evaluate the prevalence of chronic opioid use and misuse in UC.
METHODS
A retrospective chart review of UC patients seen at the University of Virginia Digestive Health Center was performed on all patients evaluated between 2006 and 2011. Patient demographics, medical, surgical, and medication histories were obtained from the electronic medical record. Concomitant diagnosis of FGID was also noted at the time. The electronic prescription monitoring program was accessed to obtain prescription opioid filling histories. Prescription opioid misuse was defined as opioid prescriptions filled from four or more prescribers and four or more different pharmacies in a 12-mo period.
RESULTS
A total of 497 patients with UC were included. Patients with UC and FGID were more likely to be female, but no other demographic variables were associated with FGID. Of the UC patients who had FGID, a greater proportion were found to be using opioids chronically (36% with FGID 9% without FGID, < 0.0001) and were misusing prescription opioids (12.8% 1.3%, < 0.001). Multivariate logistic regression demonstrated a significant association with FGID and chronic opioid use (OR = 4.50; 95%CI: 1.91-10.59) and opioid misuse (OR = 5.19; 95%CI 1.04-25.76). Tobacco use (OR 2.53; 95%CI: 1.06-6.08) and anxiety (OR 3.17; 95%CI: 1.08-9.26) were other variables associated with an increased risk of chronic narcotic use.
CONCLUSION
FGID was associated with a 4.5-fold increase in chronic opioid use and a 5-fold increased risk of opioid misuse in this patient cohort with UC.
背景
溃疡性结肠炎（UC）患者在其病程中可能会接触到阿片类药物。使用此类药物存在重大风险，包括肠道动力障碍和成瘾可能性。然而，UC患者中麻醉药品的使用和滥用率尚未得到广泛研究。功能性胃肠疾病（FGID）在UC患者中很常见，并且已被证明会增加克罗恩病患者麻醉药品使用和滥用的风险。我们假设，在我们的患者队列中，同时诊断为FGID的UC患者阿片类药物使用和滥用率会增加。
目的
评估UC患者中慢性阿片类药物使用和滥用的患病率。
方法
对2006年至2011年间在弗吉尼亚大学消化健康中心就诊的UC患者进行回顾性病历审查。从电子病历中获取患者的人口统计学、医疗、手术和用药史。同时也记录当时FGID 的伴随诊断情况。访问电子处方监测程序以获取处方阿片类药物的配药历史。处方阿片类药物滥用定义为在12个月内从四个或更多开处方者和四个或更多不同药房开具的阿片类药物处方。
结果
共纳入497例UC患者。患有UC和FGID的患者更可能为女性，但没有其他人口统计学变量与FGID相关。在患有FGID的UC患者中，发现更大比例的患者长期使用阿片类药物（FGID患者中为36%，无FGID患者中为9%，P<0.0001）且滥用处方阿片类药物（12.8%对1.3%，P<0.001）。多因素逻辑回归显示FGID与慢性阿片类药物使用（比值比=4.50；95%置信区间：1.91 - 10.59）和阿片类药物滥用（比值比=5.19；95%置信区间1.04 - 25.76）之间存在显著关联。吸烟（比值比2.53；95%置信区间：1.06 - 6.08）和焦虑（比值比3.17；置信区间：1.08 - 9.26）是与慢性麻醉药品使用风险增加相关的其他变量。
结论
在这个UC患者队列中，FGID与慢性阿片类药物使用增加4.5倍以及阿片类药物滥用风险增加5倍相关。
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