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Narcotic use for inflammatory bowel disease and risk factors during hospitalization

Long, Millie D. MD, MPH1,2,*; Barnes, Edward L. MD3; Herfarth, Hans H. MD, PhD1,2; Drossman, Douglas A. MD1,2,4

doi: 10.1002/ibd.21806
Original Article: Original Clinical Articles

Background: Growing evidence demonstrates the adverse effects of narcotics in inflammatory bowel disease (IBD). We sought to study the relationship between narcotic use, objective measures of disease activity, and other associated factors in hospitalized patients with IBD.

Methods: We performed a retrospective cohort study of all adult IBD patients admitted to a general medical or surgical ward service at a United States tertiary care center over a 1-year period. We collected demographic and disease-specific information, inpatient narcotic use, and disease activity measurements from endoscopic and radiologic reports. Bivariate comparisons were made between characteristics and narcotic use. Logistic regression was used to evaluate the independent effects of characteristics on narcotic use.

Results: A total of 117 IBD patients were included. Narcotics were given to 70.1% of hospitalized patients. Factors significantly associated with any inpatient narcotic use: Crohn's disease (CD); P ≤ 0.01, duration of IBD, P = 0.02, prior psychiatric diagnosis, P = 0.02, outpatient narcotic use, P ≤ 0.01, current smoking, P ≤ 0.01, prior IBD-specific surgery, P < 0.02, and prior IBD / irritable bowel syndrome (IBS) diagnosis, P = 0.02. Narcotic use was not significantly associated with disease severity on computed tomography (CT) scan or endoscopy. On multivariate analysis, smoking (odds ratio [OR] 4.34, 95% confidence interval [CI] 1.21–15.6) and prior outpatient narcotic use (OR 5.41, 95% CI 1.54–19.0) were independently associated with inpatient narcotic use.

Conclusions: A majority of patients with IBD are prescribed narcotics during hospitalization in spite of data on increased complications. Risk factors for narcotic use include CD and associated factors (disease duration, surgeries), substance abuse (outpatient narcotics and smoking), psychiatric diagnoses, and IBD-IBS. (Inflamm Bowel Dis 2011;)

1 Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

2 Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

3 Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

4 Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina

* CB #7080, UNC-CH, Chapel Hill, NC 27599–7080


Received 18 May 2011; Accepted 23 May 2011

Published online 7 July 2011 in Wiley Online Library (

Supported in part by a grant from the NIH for the Center for Gastrointestinal Biology and Disease: #P30 DK3497 and a Junior Faculty Career Development Award from the Crohns and Colitis Foundation of America.

© Crohn's & Colitis Foundation of America, Inc.
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