P133 PRESCRIPTION OPIOID USE AMONG VETERANS WITH INFLAMMATORY BOWEL DISEASE

Abstract

Abstract Background Opioids are commonly prescribed to manage pain in patients with IBD despite increasing evidence of harm associated with chronic use. The aim of the current study was to describe trends in opioid use among veterans with IBD. Methods This was a retrospective cohort study derived from the Veterans Affairs (VA) Health Care System. A unique patient identifier facilitated longitudinal evaluation of electronic databases that include medical diagnoses, surgical procedures, pharmaceuticals, labs, vital status information, dates of treatment, and radiology findings. Veterans were labeled as having IBD if there were at least 2 outpatient or 1 inpatient health care encounters with an ICD-9/10 diagnostic code consistent with IBD from fiscal years 2002 to 2016. Veterans without a minimum of 2 years of follow-up or who had a cancer diagnosis within 1 year before or after IBD diagnosis were excluded. In order to standardize the quantity of opioid exposure, morphine milligram equivalents (MME) for each prescription was calculated using published conversion factors. Individual prescriptions with missing quantity or day’s supply and prescriptions exceeding 1000 MME/day were excluded. Opioid exposure during the first year following the initial diagnosis date was determined as the average MME/day for those with at least one opioid prescription. Annual opioid prescribing rates per 100 IBD patients were calculated. Comorbidities were assessed using a modified Charlson Comorbidity Index (CCI), excluding cancer from the calculation. Results During the study period, 65,817 veterans with IBD were identified. The majority were males (92.1%), Caucasian (78.2%), and had a mean age of 58.2 years. In total, 1,471,019 individual opioid prescriptions were evaluated. The quantity and rate of opioid prescriptions peaked in 2012, with 115,774 unique prescriptions and 698.5 opioid prescriptions per 100 IBD patients, respectively. Twenty-seven percent (n=17,844) of IBD patients had at least one opioid prescription within the initial year of diagnosis. Mean opioid exposure during the initial year of diagnosis averaged 33.2 MME/day, and 12.2% had mean opioid exposure greater than 50 MME/day. Opioid exposure peaked in 2005 at 37.4 MME/day and consistently declined to 29.3 MME/day in 2016. Conclusion There has been a significant decline in opioid prescriptions, prescribing rate, and mean opioid exposure since peaking in 2012. These trends are similar to those seen in the non-veteran US population.