Narcotic use common in Crohn’s disease patients

NEW YORK (Reuters Health) – 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.