Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Inflamm Bowel Dis. 2021 Mar 15;27(4):500-506. doi: 10.1093/ibd/izaa104.
Opioid use is associated with excess mortality in patients with inflammatory bowel disease (IBD). Recent data have highlighted that inpatient opioid exposure is associated with postdischarge opioid use in this population. It is unknown if preadmission use of cannabis, which is commonly used for symptom relief among patients with IBD, increases the risk for inpatient opioid exposure when patients lack access to cannabis for symptom management. We sought to determine the association between preadmission cannabis use and inpatient opioid exposure while adjusting for relevant confounders.
We performed a retrospective cohort study of adult patients hospitalized for IBD within a large academic health system from March 1, 2017, to April 10, 2018. Opioid exposure was calculated by converting the sum of administered opioid doses to intravenous morphine milligram equivalents and dividing by length of stay. We used multivariable linear regression to assess the association between cannabis use and inpatient opioid exposure while adjusting for confounders including IBD severity and preadmission opioid use.
Our study included 423 IBD patients. Linear regression analysis showed a significant positive correlation between inpatient opioid exposure (intravenous morphine milligram equivalents divided by length of stay) and preadmission cannabis use (coefficient = 12.1; 95% confidence interval [CI], 2.6-21.5). Other significantly associated variables were first patient-reported pain score (coefficient = 1.3; 95% CI, 0.6-2.0) and preadmission opioid use (coefficient = 22.3; 95% CI, 17.0-27.6).
Cannabis use is positively correlated with inpatient opioid exposure after controlling for confounders. A personalized pain management approach should be considered to limit inpatient and possibly future opioid exposure among hospitalized patients with IBD who use cannabis.
阿片类药物的使用与炎症性肠病（IBD）患者的超额死亡率有关。最近的数据强调，在该人群中，住院期间阿片类药物的暴露与出院后的阿片类药物使用有关。目前尚不清楚在患者无法获得大麻来缓解症状的情况下，用于缓解 IBD 患者症状的大麻的入院前使用是否会增加住院期间阿片类药物暴露的风险。我们试图确定在调整相关混杂因素的情况下，入院前大麻使用与住院期间阿片类药物暴露之间的关联。
我们对 2017 年 3 月 1 日至 2018 年 4 月 10 日期间在一家大型学术医疗系统中因 IBD 住院的成年患者进行了回顾性队列研究。通过将给予的阿片类药物剂量转换为静脉注射吗啡毫克当量，并除以住院时间来计算阿片类药物暴露量。我们使用多变量线性回归来评估大麻使用与住院期间阿片类药物暴露之间的关联，同时调整包括 IBD 严重程度和入院前阿片类药物使用在内的混杂因素。
我们的研究包括 423 名 IBD 患者。线性回归分析显示，住院期间阿片类药物暴露（静脉注射吗啡毫克当量除以住院时间）与入院前大麻使用之间存在显著正相关（系数=12.1；95%置信区间 [CI]，2.6-21.5）。其他显著相关的变量是首次患者报告的疼痛评分（系数=1.3；95%CI，0.6-2.0）和入院前阿片类药物使用（系数=22.3；95%CI，17.0-27.6）。
在控制混杂因素后，大麻使用与住院期间阿片类药物暴露呈正相关。对于使用大麻的住院 IBD 患者，应考虑采用个性化疼痛管理方法来限制住院期间和可能未来的阿片类药物暴露。
