Narcotic use common in Crohn’s disease patients

Chronic narcotic use is common in patients with Crohn’s disease, and is associated with increased disease activity and decreased quality of life.

Dr. Raymond K. Cross, of the University of Maryland, Baltimore, and colleagues examined the prevalence of narcotic use and contributing factors in a review of 291 patients with Crohn’s disease who were followed for 5 years. The results of the study are published in the American Journal of Gastroenterology.

Narcotic use was identified in 38 (13.1 percent) patients. Narcotic users were more likely to be older and female. Patients who used narcotics were also more likely to have higher rates of disability (15.4 percent versus 3.6 percent) and a longer duration of disease (17.0 versus 12.9 years).

Patients using narcotics used an average of 6.97 medications compared with 4.7 in the non-users, and had a higher prevalence of neuropsychiatric drug use (37 percent versus 19 percent). Disease activity scores were higher among patients using narcotics, and quality of life was decreased,

An analysis of the data showed a significant positive association between narcotic use and active disease, use of more than one drug and smoking, Cross and colleagues report. “Female sex, disability, and duration of disease were not significantly correlated with narcotic use after adjusting for independent variables.”

The researchers conclude that Crohn’s disease patients using narcotics should undergo a thorough examination to identify untreated active disease. Patients who have symptoms of intermittent partial small bowel obstruction should be assessed for subtle strictures that may be underdiagnosed by barium imaging tests.

“The prescription of opioids for long-term use in irritable bowel disease patients is fraught with difficulty, as it may lead to opioid dependence and gastrointestinal dysfunction,” Dr. Edward V. Loftus and colleagues from the Mayo Clinic, Rochester, Minnesota, write in an accompanying editorial.

“These adverse effects may lead to confusion regarding the status of irritable bowel disease activity,” they point out, “and can result in overtreatment of symptoms with anti-inflammatory or immunosuppressive therapy, further dose escalation of narcotics, and hence, a vicious cycle resulting in significant physical and psychological disability.”

SOURCE: American Journal of Gastroenterology, October 2005.

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