P1087 Opioid Use Before and After Ulcerative Colitis Diagnosis: A Nationwide Cohort Study in Sweden 2006-2021
Authors: Osooli M , Voghera S , Bruze G , Nordenvall C , Myrelid P , Everhov Å H , Ludvigsson J F , Olén O 
Published: January 2025

Abstract

Background
Opioid misuse has been declared in the US since 2017 [1]. Population-based studies to describe opioid use among adults with ulcerative colitis (UC) are scarce [2]. This study aimed to evaluate patterns of opioid use two years before and up to five years after UC diagnosis date among adults with UC compared to reference individuals in Sweden.

Methods
We conducted a nationwide cohort study including individuals aged ≥18 years with an incident UC diagnosis between 2008 and 2019, identified through two International Classification of Disease 10 code K51 recorded in the National Patient Register. Each patient with UC was matched with up to 10 reference individuals without inflammatory bowel disease (IBD) by birth year, sex, calendar year, and place of residence. Observation started on January 1, 2006, age 18, or 24 months before the first UC diagnosis date (index date), whichever came last, and ended at emigration, death, or December 31, 2021. Data on opioid dispensations were obtained from the Prescribed Drug Register. Opioid use was defined as ≥1 dispensed opioid prescription per six-months periods. We categorized opioids as weak (codeine combinations, tramadol, dextropropoxifen) and strong (oxycodone, morphine, hydromorphone, fentanyl, buprenorphine, tapentadol, petidine). Opioid use during 24 months before the index date was classified as non-use (no dispensations), intermittent use (≥1 dispensation in 1–3 of the four preceding six-month periods), or chronic use (≥1 dispensation in all four six-months periods). Mean daily doses (MDD) of opioids were calculated using oral morphine equivalents. Opioid use prevalence and MDDs were reported with 95% confidence intervals.

Results
The cohort included 20,265 patients with incident UC (48.7% female) and 185,973 reference individuals. At the index date, 2.4% of UC patients and 1.4% of reference individuals chronically used opioids, while 15.0% and 11.1% used opioids intermittently. Among patients with UC, opioid use increased right after the index date to 12.0% and stabilized at approximately 10% thereafter (Figure 1). The use of stronger opioids increased after diagnosis, while the use of weak opioids remained unchanged (data not shown). The MDD of opioids among patients with UC increased from 0.75 mg (0.60 mg in the reference group) at 18-24 months before the index date to 1.45 mg (0.65 mg in the reference group) at 54-60 months post-diagnosis.

Conclusion
Overall prevalence of opioid use among adults with UC increased only modestly following diagnosis, with a shift toward using stronger opioids. The main limitation of this research was the inability to account for illegal opioid use, which may result in underestimating the use of opioids among the reference group.

References
1.Scholl, L., et al., Drug and Opioid-Involved Overdose Deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep, 2018. 67(5152): p. 1419-1427.
2.Niccum, B., et al., Opioid Use Among Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol, 2021. 19(5): p. 895-907 e4.