Narcotic Use in Children with IBD Common, Despite Warnings

the MPR take:

Chronic narcotic use is common in pediatric patients with inflammatory bowel disease (IBD) despite the fact that they are not recommended for long-term pain management for IBD in children and adults, reports a new study in Clinical Gastroenterology and Hepatology. Data obtained from an administrative health claims database identified 4,344 children with IBD (63% with Crohn’s disease, 37% with ulcerative colitis), predominately ages 15–18. Over the study period from January 1, 2010 to December 31, 2011, 5.6% of children with IBD were chronic narcotic users (defined as having at least three narcotic drug claims during the two year time frame) vs. 2.59% of matched members of the general population. In particular, the association between IBD and chronic narcotic use was significantly higher among those with both IBD and psychological impairment ((POR, 6.75; 95% CI, 4.29–10.62) compared to those with only IBD (POR, 2.27; 95% CI, 1.91–2.70). Factors for higher risk of chronic narcotic use included older age, living outside of the Northeast, acute sinusitis/headache, fracture, joint pain, psychological impairment, and all markers of healthcare utilization. Prescriptions for azathioprine/6-mercaptopurine were significantly associated with a lower risk of chronic narcotic use. Because long-term narcotic use among children with IBD is not recommended due to gastrointestinal side effects, disease complications, and the potential for dependency, the study authors recommend increased awareness of psychological comorbidity, screening, and treatment of disorders such as anxiety and depression to reduce symptoms that may lead to chronic narcotic use.

Narcotic analgesics are not recommended for long-term management of pain for patients with inflammatory bowel disease (IBD), particularly pediatric patients. We compared chronic use of narcotics among children with IBD and the general population and investigated factors associated with narcotic use in the pediatric IBD population.

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