Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Dig Dis Sci. 2022 Dec;67(12):5493-5499. doi: 10.1007/s10620-022-07459-y. Epub 2022 Mar 19.
Patients with chronic pancreatitis (CP) often require opioids for pain control. The goal of our study was to characterize opioid use in patients with CP in a real-life practice using a state-mandated online monitoring program and to assess outcomes compared to CP patients without opioid dependency.
CP patients seen in our Pancreas Center from 2016 to 2021 were divided into two groups-with and without chronic opioid use. Details of opioids and other controlled prescriptions were obtained by review of the Massachusetts Prescription Awareness Tool (MassPat).
Of the 442 CP outpatients, 216 used chronic opioids. Patients with opioid use had significantly more recurrent acute pancreatitis (76.6% vs. 52.7%), concurrent alcohol use (11.2% vs. 5.8%), tobacco use (37.8% vs. 19.7%), anxiety (22.4% vs. 16.6%), depression (43.5% vs. 23.5%) and daily pain (59.8% vs. 24.8%) (p < 0.001). They also concurrently used more benzodiazepines (43.7% vs. 12.4%), gabapentinoids (66.4% vs. 31.1%) and medical marijuana (14.9% vs. 4.19%) (p < 0.001). They had more celiac plexus blocks (22.0% vs. 6.67%), surgery (18.3% vs. 8.89%) and more hospitalizations for CP flares (3.6 vs. 1.0 visits) (p < 0.001). Less than 13% patients received opioids by means of ED visits; 81.7% patients received their prescriptions from one facility and 75% received them at regular intervals.
Opioid-dependent CP patients exhibit polypharmacy and have worse outcomes with higher resource utilization. The state-monitoring program ensures that the majority of patients receive opioids from a single facility, thereby minimizing misuse.
慢性胰腺炎（CP）患者常需要使用阿片类药物来控制疼痛。我们的研究目的是通过州政府要求的在线监测项目来描述真实环境中 CP 患者的阿片类药物使用情况，并评估与无阿片类药物依赖的 CP 患者相比的结果。
我们从 2016 年至 2021 年在胰腺中心就诊的 CP 门诊患者分为两组-使用和不使用慢性阿片类药物。通过审查马萨诸塞州处方意识工具（MassPat）获得阿片类药物和其他受控处方的详细信息。
442 名 CP 门诊患者中，216 名患者使用慢性阿片类药物。使用阿片类药物的患者复发性急性胰腺炎（76.6%比 52.7%）、同时饮酒（11.2%比 5.8%）、吸烟（37.8%比 19.7%）、焦虑（22.4%比 16.6%）、抑郁（43.5%比 23.5%）和每日疼痛（59.8%比 24.8%）更为严重（p<0.001）。他们同时使用更多的苯二氮䓬类药物（43.7%比 12.4%）、加巴喷丁类药物（66.4%比 31.1%）和医用大麻（14.9%比 4.19%）（p<0.001）。他们接受的腹腔神经丛阻滞术（22.0%比 6.67%）、手术（18.3%比 8.89%）和 CP 发作的住院治疗（3.6 次比 1.0 次就诊）更多（p<0.001）。不到 13%的患者通过急诊就诊获得阿片类药物；81.7%的患者从一家机构获得处方，75%的患者定期获得处方。
依赖阿片类药物的 CP 患者表现出药物滥用，并伴有更高的资源利用率和更差的结果。州政府的监测项目确保大多数患者从单一机构获得阿片类药物，从而最大限度地减少药物滥用。
