THE OPIOID EPIDEMIC: ASSESSING OUTCOMES OF OPIOID ABUSE IN CHRONIC INFLAMMATORY DISEASE (ULCERATIVE COLITIS VS CROHN’S DISEASE)
Authors: Dasu Neethi , Khalid Yaser , Blair Brian , Derosa Justin , McMahon Donald 
Published: January 2022

Abstract

BACKGROUND
The use of Opiates in patients with Inflammatory Bowel Disease (IBD) has been studied previously. However, to our knowledge, no studies have compared outcomes between patients with opioid abuse with ulcerative colitis (UC) versus patients with opioid abuse and concomitant Crohn’s disease (CD). Our study aims to investigate the impact on hospital mortality, hospital length of stay (LOS), and total charges between both patient groups.

METHODS
All patients aged 18 years and above with UC and CD as well as opiate abuse disorder, from 2016-2019 were identified from the US Nationwide Inpatient Sample (NIS). The NIS is a large, publicly available all-payer inpatient care database in the USA. The primary outcome evaluated was inpatient mortality. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay, and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics. STATA software was used for analysis.

RESULTS
Among 35,734 patients who had opioid abuse, 7,980 (22.3%) patients had UC and 27,949 (77.7%). The adjusted odds ratio (OR) for both inpatient mortality (OR 1.13, p=0.692) and hospital length of stay (LOS) (+0.62 days, p=0.09) for opioid abuse with UC compared to those with Crohn’s disease were not statistically significant. However, total hospital charges were $8,649 higher (p&lt;0.018) in patients with UC. Independent positive predictor of increased mortality was older age (p&lt;0.0001). Independent positive predictors of increased LOS and total hospital charges were the following: fistula formation (+10.1 days, +$118,312, p&lt;0.001 for both), bowel obstruction (+2.5 days, p&lt;0.006; +$16,685, p&lt;0.036), hematochezia (+3.1 days, p&lt;0.02; +$30,168, p&lt;0.018), electrolyte abnormalities (+2.0 days, p&lt;0.001; +$26,450, p&lt;0.0001), colonoscopy (+2.5 days, p&lt;0.001; +$19,102, p&lt;0.005), bowel resection (+11.9 days, p&lt;0.0001; +$131,750, p&lt;0.0001). Total charges were also increased for white patients (+$13,236, p&lt;0.016), black patients (+$28,070, p&lt;0.008), Hispanic patients (+$25,970, p&lt;0.0008).

CONCLUSION
Our study shows that there is no difference in mortality or LOS in patients with opioid abuse with UC versus those with CD. However, total charges are significantly higher for UC patients with opioid abuse. Also, elderly patients with UC are at increased risk for mortality. Opioid abuse in the IBD population is common, given that symptoms of disease activity often include pain. However, the abuse of opiates has led to an opioid crisis in the United States. It is interesting to note the disparity between patients with UC vs CD. This needs to be studied further in randomized trials to help mitigate adverse outcomes in this patient population.