S57 Opioid Use Patterns in Patients With Chronic Pancreatitis and Concomitant Mental Illness: A Propensity-Matched Cohort Analysis

Abstract

Introduction: Chronic pancreatitis (CP) is commonly associated with pain that can be difficult to manage. This can result in high rates of healthcare utilization and chronic opioid use. Many patients with CP have concomitant mental health disorders (MHDs) which may be associated with greater disease burden. Genetic links between CP-associated pain and MHDs have been described. Given the current opioid epidemic trend, it is critical to assess whether concomitant MHDs affect opioid usage patterns in patients with CP. The aim of this study was to identify whether patients with coexisting CP and mental illness have higher opioid usage compared to their counterparts without any diagnosed mental illness. Methods: This was a large cohort study using TriNetX, which links anonymized inpatient and outpatient electronic health record data from more than 80,000,000 patients. We created two cohorts: patients with chronic pancreatitis from 2010-2020 with and without co-existing mental health disorders. The cohorts underwent 1:1 propensity matching based on age, sex, race, ethnicity, and alcohol and nicotine dependence. The primary outcome was a new diagnosis of opioid use disorder at 3 years after the first diagnosis of CP. Secondary outcomes at 3 years included any opioid use, long-term opioid use, opioid overdose, and all-cause mortality. Results: After matching, two cohorts of 48,960 patients remained for analysis. All covariates were well-matched. In the MHD cohort, 51.6% had mood /affective disorders (F30-39), 49.5% had anxiety (F40-48), and 5.9% had non-mood psychotic (F20-29). At 3 years, the MHD cohort had a near 5-fold increase in the rate of opioid use disorder (7.1% vs 1.6%, OR =4.8, 95% CI 4.4-5.2). The MHD cohort also had significantly higher rates of any opiate use,(OR 1.5, 95% CI 1.4-1.5), long-term opioid use (OR 2.2, 95% CI 2.1-2.3), opioid overdose (OR 4.2, 95% CI 3.7-4.6), and all-cause mortality (OR 1.3, 95% CI 1.2-1.3) (Table). Conclusion: In propensity-matched cohorts, patients with CP and concomitant MHDs had higher rates of opioid use disorder, long-term use, overdose, and all-cause mortality compared with those without MHDs. As CP-related pain has been shown to be augmented in patients with MHDs – specifically depression – identifying this opioid risk is critical in the management of these patients. Table 1. - Measures of Association. CP w/ MHD: chronic pancreatitis with mental health disorder cohort, CP w/o MHD: chronic pancreatitis without mental health disorder cohort Outcome Patients with outcome (% risk), CP w/ MHD Patients with outcome (% risk), CP w/o MHD Odds Ratio (OR) 95% Confidence Interval (CI) p-value Opioid use disorder (dependence or abuse) 3,467 (7.1%) 767 (1.6%) 4.8 4.4-5.2 < 0.0001 Opiate use (ever) 13,846 (28.3%) 10,310 (21.1%) 1.5 1.4-1.5 < 0.0001 Adverse opiate event 592 (1.2%) 158 (0.3%) 3.8 1.4-1.5 < 0.0001 Opiate overdose 1,809 (3.7%) 448 (0.9%) 4.2 3.7-4.6 < 0.0001 Long-term opiate analgesic use 9,896 (20.2%) 5,046 (10.3%) 2.2 2.1-2.3 < 0.0001 All-cause mortality 6,958 (14.4%) 5,702 (11.8%) 1.3 1.2-1.3 < 0.0001