The prevalence of chronic narcotic use among pediatric patients with inflammatory bowel disease is abnormally high and should be curbed to prevent further adverse effects from taking hold, according to a new study published in the February issue of Clinical Gastroenterology and Hepatology.
“Although pain control is an important aspect of disease management in pediatric IBD [inflammatory bowel disease], little is known about chronic narcotic use in children,” wrote the investigators, led by Dr. Jessie P. Buckley of the University of North Carolina at Chapel Hill. They added that “although children with Crohn’s disease are at increased risk of anxiety and depression, the relationship between narcotic use and psychiatric conditions has not yet been assessed in the pediatric IBD population (Clin. Gastroenterol. Hepatol. 2015 February [doi:10.1016/j.cgh.2014.07.057].”
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Children with IBD were more than twice as likely to be prescribed chronic narcotics than their peers.
In a retrospective, cross-sectional study, Dr. Buckley and her associates counted all 4,911,286 patients aged 18 years or younger with continuous health plan enrollment and pharmacy benefits in the MarketScan Commercial Claims and Encounters database between January 1, 2010 and December 31, 2011. Children were defined as having IBD if they had either three or more health care visits for Crohn’s disease or ulcerative colitis during the study’s time frame, or “at least one health care contact for Crohn’s disease or ulcerative colitis and at least one pharmacy claim for any of the following medications: mesalamine, olsalazine, balsalazide, sulfasalazine, 6-mercaptopurine, azathioprine, methotrexate, enteral budesonide, or biologics (infliximab, adalimumab, certolizumab,or natalizumab).”
From this population, the authors used diagnosis codes based on data from the U.S. National Drug Code system, the European Pharmaceutical Market Research Association, and the Pharmaceutical Business Intelligence and Research Group Anatomical Classification System drug classes, along with information on dispensation of IBD medications, to select 4,344 IBD patients, each of whom was subsequently matched with 5 other patients without IBD based on age, sex, and geographic region within the United States (Northeast, North Central, South, or West), yielding 21,720 in this population. Subjects were defined as chronic users if they “had at least three narcotic drug claims during the 2-year study period.” Within the IBD population, 2,737 (63%) of subjects had Crohn’s disease and 1,607 (37%) had ulcerative colitis.
Investigators found that 5.6% (241 individuals) of the 4,344 subjects with IBD were chronic narcotic users, significantly higher than the 2.3% rate (489 subjects) of chronic narcotic use found in the non-IBD population (prevalence odds ratio, 2.59; 95% confidence interval, 2.21–3.04). Furthermore, chronic narcotic use was more prevalent in IBD patients with psychological impairment than those without: 15.7% (POR, 6.8; 95% CI, 4.3–10.6) versus 3.2% (POR, 2.3; 95% CI, 1.9–2.7), respectively. In children with IBD, older age and chronic narcotic use were also more highly associated with “increased health care utilization [and] fracture.”
“Children with IBD had more than twice the prevalence of chronic narcotic use as children without, and associations between IBD status and narcotic use indicate particularly high burden among those with concomitant anxiety or depression,” Dr. Buckley and her associates wrote, adding that “psychiatric diagnoses have also been associated with increased risk of narcotic use among adult patients with IBD. Greater attention to the complex relationships between pain and psychological impairment is warranted because children with IBD are at increased risk of anxiety and depression, compared with their peers, and other cofactors are not easily intervened on (e.g., age, region, fracture).”
The authors disclosed that financial support for this study was provided, at least in part, by GlaxoSmithKline (GSK). Dr. Buckley received funding through a research assistantship at GSK, coauthors Dr. Suzanne F. Cook and Dr. Jeffery K. Allen are employees of GSK, and coauthor Dr. Michael D. Kappelman is a consultant to GSK, among other companies.