841 The Impact of Inpatient Intravenous Opioids on Future Outpatient Opioid Exposure Among Hospitalized Patients With Inflammatory Bowel Disease

Abstract

INTRODUCTION: Patients hospitalized for inflammatory bowel disease (IBD) often receive opioids (OPIs) to control pain. However, OPI use is associated with excess mortality and infections in IBD patients (AJG 2012;107(9):1409-22). Given the high potency of intravenous (IV) OPIs and their unclear impact on future OPI exposure, we sought to determine if IV OPI use is associated with subsequent outpatient OPI prescriptions (Rx) among hospitalized IBD patients. METHODS: We performed a retrospective cohort study of patients aged >18 years hospitalized at a large urban academic health system from 3/1/17 to 4/10/18. Patients were included if they were admitted to observation, general medical, general surgical, or gastrointestinal surgical services, had a discharge diagnosis of IBD, and had >1 outpatient office visit in the department of gastroenterology within 12 months of discharge. IBD history, patient-reported pain scores, and demographic, medication administration, and outpatient Rx data were abstracted from the electronic health record. We used multivariable mixed effect logistic regression modeling (MVMELR) to account for repeat encounters and to assess the association between IV OPI exposure and an outpatient OPI Rx provided within 12 months after discharge while adjusting for confounders. IV OPI exposure was represented both as a binary variable and a continuous variable in total IV morphine mg equivalents/length of stay in days (IVMMEs/d). Kaplan-Meier (KM) analysis was performed to compare time to outpatient OPI Rx by inpatient OPI exposure. RESULTS: We included 709 encounters among IBD patients between 3/1/17 and 4/10/18. Patient characteristics and unadjusted outcomes by OPI exposure are presented in Table 1. MVMELR demonstrated a significant association between IV OPI exposure (binary predictor: OR 2.9, 95% CI 1.4-5.9; continuous predictor in IVMMEs/d: OR 1.0, 95% CI 1.0-1.1) and an outpatient OPI Rx within 12 months of discharge. Receiving only non-IV OPIs was not associated with an opioid Rx (OR 0.8, 95% CI 0.3-2.4; Table 2). KM analysis demonstrated significant separation in rate curves for OPI Rx between OPI exposure groups (log rank test P < 0.01; Figure 1). CONCLUSION: Administration of IV OPIs to hospitalized IBD patients may increase their risk for further OPI exposure after discharge. IV OPIs should be used judiciously in this high-risk population with consideration of appropriate alternatives. Additional research is needed to identify long-term risks of IV OPI use in patients with IBD.