Chronic opioid use and the risk of infections and death in patients with inflammatory bowel disease: a nationwide cohort study based on real-world data.

Nørgård BM, Zeiss KE, Dalal RS, Lund K, Andersen ML, Kjeldsen J, Knudsen T, Nielsen J.

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AI summary — for doctors, generated from the abstract only

Chronic opioid use in IBD was associated with nearly double the risk of infection and death.

What was studied

Danish nationwide cohort of 18,897 Crohn and 32,947 UC patients with time-varying chronic opioid use.

Key findings

Crohn: infections aHR 1.91, antibiotics 1.47, death 1.76
UC: infections aHR 1.93, antibiotics 1.56, death 1.74
Both strong and weak opioids were associated with harm

Clinical relevance

Gives another reason to avoid opioids in IBD.

Who should care

Medical Gastroenterology

Limitations

Observational; confounding by disease severity is possible.

Avoid chronic opioids in IBD and seek alternative pain management.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Background

Chronic opioid use (COU) is frequent in inflammatory bowel disease (IBD), but data on its association with infections and mortality are scarce. We examined (1) hospital-diagnosed infections, (2) prescribed systemic antibiotic/antiviral/antifungal agents, and 3) death associated with COU, and assessed these outcomes according to opioid strength.

Methods

This nationwide cohort study included all prevalent adult patients with Crohn disease (CD) and ulcerative colitis (UC) in Denmark from January 1, 2000, to June 30, 2023. Chronic opioid use (COU) was a time-varying exposure (≥3 opioid prescriptions within 12 months, with ≥ 30 days between each prescription). Cox regression models were used to estimate adjusted hazard ratios (aHRs), including baseline and time-varying covariates (IBD surgery, IBD medications, and psychotropic medications).

Results

We included 18 897 patients with CD, of whom 3948 (20.9%) had COU. Among those with COU, the aHRs for hospital-diagnosed infections, prescribed antibiotics, and death were 1.91 (95% CI, 1.79-2.04), 1.47 (95% CI, 1.40-1.56), and 1.76 (95% CI, 1.58-1.96), respectively. We included 32 947 patients with UC, of whom 4779 (14.5%) had COU. Among those with COU, the aHRs for hospital-diagnosed infections, prescribed antibiotics, and death were 1.93 (95% CI, 1.80-2.06), 1.56 (95% CI, 1.47-1.65), and 1.74 (95% CI, 1.60-1.90), respectively. Both strong and weak opioids were associated with these adverse outcomes in CD and UC.

Conclusions

Real-world data have demonstrated an association between COU and increased risks of infections and mortality, independent of opioid strength, affecting users of both strong and weak opioids. Clinicians should be attentive to these risks when prescribing opioids to this population.

DOI

10.1093/ibd/izag085

PMID

42219534

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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