Opioid use as a driver of cost of IBD care

Approximately 50-70% of IBD patients report experiencing abdominal pain at some point during their disease journey. But when that pain becomes chronic, treating it can become difficult and costly. In fact, the results from the Foundation’s Cost of IBD Care study from 2019 found that prescription opioid use was one of the top drivers of increased patient cost of care.

As many as 57% of Crohn’s patients and 33% of ulcerative colitis patients deal with chronic abdominal pain because of active inflammation, complications such as strictures, increased sensitivity of the nerves that line the bowels (known as visceral hypersensitivity), and other causes. According to research, opioids are prescribed commonly for IBD patients with chronic abdominal pain – 5-20% of IBD outpatients and up to 70% of those who are hospitalized. 

Previous research identified several risk factors, in addition to chronic pain, for chronic opioid use among IBD patients, including:

• Female gender
• Comorbid history of psychiatric conditions, particularly depression and substance abuse disorders
• Having two or more IBD-related surgeries
• Surgery
• Being on five or more medications
• Sexual, physical, or emotional abuse history
• Functional disability, such as inability to work or perform routine tasks.

With the ongoing conversations nationally about the opioid epidemic in our country, we wanted to understand why opioid use drives up patient cost of care. To do that, we analyzed the data gathered from our cost of care study and recently published the findings in Crohn’s & Colitis 360.

The analysis showed that of the 51,178 IBD patients included in our data sample, 35% had used opioids either acutely, moderately, or chronically. Among those individuals, outpatient visits, emergency department visits, inpatient hospitalizations, and total medical and pharmacy costs were higher among those who used opioids. Those utilizing opioids had higher average costs in the following categories:

• Outpatient care
• Emergency department visits
• Inpatient stays
• Pharmacy costs

So, what does this mean?

We know that chronic pain represents an unmet need for IBD patients. Unfortunately, this won’t be a quick fix, but the Foundation is leading the way by bringing together key stakeholders in pain research for our new Pain Initiative. Through this new program, we are working to improve our understanding of the biological mechanisms that cause chronic IBD pain so that we can develop more effective ways of helping patients manage this challenge.

According to the paper summarized above, providers recommend keeping patients on low doses and short durations of opioid if possible. There are additional medication options that may be helpful for some patients experiencing pain, such as antidepressants, antispasmodics, or anti-inflammatories. Some patients also find pain relief using complementary therapies such as mind-body therapies, light physical exercise, or physical therapy.

If you are experiencing chronic pain with your disease, you are not alone, and you might find it helpful to seek support. Taking care of your mental health can help you feel better not only emotionally but physically as well. Support groups are a great way to connect with others who understand what you’re going through. You can also find a mental health provider with experience treating IBD patients, including those with chronic pain, in the Rome Foundation’s Psychogastroenterology Directory. And you can always reach out to our IBD Help Center at [email protected] or 888MYGUTPAIN with any questions that you have.