ER opioid use for IBD patients

November 23, 2021

Issue 22

Clinical Question

How often do IBD patients receive opioids in the Emergency Department or at discharge?

Editor’s Bottom Line

Many patients with IBD continue to receive narcotics for short-term pain management. Better tools and strategies to manage IBD-related pain are needed.

Reference

Chhibba T, Guizzetti L, Seow CH, et al. Frequency of Opioid Prescription at Emergency Department Discharge in Patients with Inflammatory Bowel Disease: A Nationwide Analysis. Clin Gastroenterol Hepatol. 2021;19(10):2064–71.e1; https://doi.org/10.1016/j.cgh.2020.07.020

Synopsis

To identify patterns of opioid use and opioid discharge prescribing patterns for IBD patients seeking emergency care, researchers analyzed data gathered between 2006–2017 as part of the US National Hospital Ambulatory Medical Care Survey (NHAMCS). They included data from 965,000 emergency department visits not resulting in hospital admission for patients with IBD as their primary reason for care. Most patients had Crohn’s disease. The majority were white and presented with moderate to severe pain.

The authors found that 51.9% (95% Confidence Interval [CI], 42.2–61.6) received an opioid during their emergency department visit and 35.3% received an opioid prescription at the time of emergency department discharge (95% CI, 26.5–45.2). Opioid use and discharge prescribing trended downward in 2015–2017, when 48.7% of IBD patients received an opioid during their emergency department visit and only 24.2% received an opioid prescription at the time of discharge.

Significant predictors of opioid receipt during emergency department stays included more severe pain (adjusted odds ratio [aOR]: 5.22; 95% CI, 1.52–17.91; P<0.01) and longer visit duration (aOR: 4.06; 95% CI, 1.72–9.61; P<0.01), while white patients were less likely to receive an opioid than non-white patients (aOR: 2.22; 95% CI, 0.06–0.72; P=0.01). Significant predictors of an opioid prescription at discharge were more severe pain (aOR: 5.06; 95% CI, 1.72–14.9; P<0.01) and use of opioids during the emergency department stay (aOR: 5.07; 95% CI, 1.89–13.61; P<0.01).

Details

Study Design: Database analysis

Funding: Not stated

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2a