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Trends in Narcotic and Corticosteroid Prescriptions in Patients with Inflammatory Bowel Disease in the United States Ambulatory Care Setting from 2003 to 2011

Narula, Neeraj MD*,†; Borges, Lawrence MD§; Steinhart, A. Hillary MD, MSc†,‡; Colombel, Jean-Frederic MD, PhD

doi: 10.1097/MIB.0000000000001084
IBD LIVE Articles

Background/Hypothesis: Before the availability of biological therapies, corticosteroids and narcotics were frequently used in patients with inflammatory bowel disease (IBD) because of a paucity of disease-modifying therapies. The increased accessibility to effective biologicals for IBD over the last decade should be leading to less use of corticosteroids and narcotic medications. This study aims to examine trends in prescriptions of corticosteroids and narcotics to patients with IBD in the United States during the period 2003 to 2011.

Methods: Data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were used to examine visits of patients with IBD. Trends in corticosteroid and narcotic prescriptions were explored, and predictors of use were assessed using survey-weighted chi-square tests.

Results: From 2003 to 2011, a total of 1119 patients with IBD had visits recorded in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey databases. Although biological prescriptions significantly increased from 3.3% in 2003 to 2005 to 15.9% in 2009 to 2011 (P = 0.004), there was no significant decrease in corticosteroid or narcotic prescriptions during this same time frame. Patients with IBD were less likely to receive narcotics (odds ratio = 0.38) when seeing a medical specialist compared with primary care physicians or surgeons.

Conclusions: Despite the availability of more effective biological therapies, prescriptions for corticosteroids and narcotics did not decline in patients with IBD visiting U.S. ambulatory clinics and emergency departments from 2003 to 2011.

Article first published online 31 March 2017.

*Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada;

Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada;

Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;

§Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts; and

Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.

Address correspondence to: Neeraj Narula, MD, McMaster University Medical Centre, 1280 Main Street West, Unit 3V28, Hamilton, ON L8S 4K1, Canada (e-mail: Neeraj.narula@medportal.ca).

The authors have no conflict of interest to disclose.

Guarantor of the article: N. Narula. All authors approved the final version of the manuscript.

Received December 18, 2016

Accepted January 25, 2017

© Crohn's & Colitis Foundation
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