Digestive Disease Week (DDW) 2010: Abstract W1378. Presented May 5, 2010.
Although inflammatory bowel disease (IBD) can be extremely painful, narcotics are inadvisable for this condition. Even so, a sizeable proportion of patients are inappropriately prescribed these drugs, according to one of the first surveys to quantify narcotic use among patients with IBD, presented here at Digestive Disease Week 2010.
"Narcotics use is exceedingly common in patients with IBD. Why should we worry? We should worry for a lot of reasons: first, these drugs do not help noncancer patients' bowel function; second, they carry a risk of drug dependency; and third, they may actually worsen symptoms of IBD," stated Spencer D. Dorn, MD, assistant professor of medicine at the University of North Carolina in Chapel Hill.
He described a newly identified condition called narcotic bowel syndrome, in which narcotics paradoxically increase abdominal pain, particularly at higher doses.
An Internet-based survey was sent to nearly 1800 patients who had seen a physician for irritable bowel syndrome (IBS) as defined by Rome III criteria. The researchers examined demographics, clinical characteristics, clinical features (including subtype, duration, and severity), most troublesome symptom, quality of life, psychological factors (such as anxiety and depression), overall satisfaction with care, and current medications.
In all, 325 adult patients (18%) reported current use of narcotics (excluding tincture of opiate, prescribed as an antidiarrheal medication).
Dr. Dorn said that patients who used narcotics had more severe IBS and worse physical and mental health than those who did not. Significant predictors of narcotic use included poor self-rated health (P < .0001), pain as the most bothersome symptom (P < .0001), number of bothersome symptoms (P = .008), number of hospitalizations (P < .01), number of lifetime surgeries (P < .0001), current antidepressant use (P = .01), current anxiolytic use (P < .02), and current antiacid use (P = .01).
Dr. Dorn and colleagues recommend a multidisciplinary approach to the management of IBS, which emphasizes patient education, self-management over time, nonnarcotic symptom-based therapies and, in some cases, antidepressants and/or psychotherapy.
Such an approach is challenging in the current healthcare environment, he acknowledged. "Clinicians often lack the time, infrastructure, and incentives needed to provide this type of care to patients with IBD and other chronic conditions. Instead, they often take the path of least resistance. Narcotic prescriptions are a quick and easy way to get patients out of their offices, even though the long-term effects can be harmful."
Dr. Dorn told meeting attendees that this study did not quantify recreational narcotic use — only narcotic prescriptions. He also pointed out that although the United States comprises only 4% of the world's population, our country accounts for more than 80% of narcotics prescribed worldwide.
Commenting on this presentation, moderator Deborah Proctor, MD, professor of medicine and medical director of the IBD Program at Yale University in New Haven, Connecticut, said that "gastroenterologists and other doctors who treat patients with IBD should rethink prescribing narcotics. Instead, they should first try [nonsteroidal anti-inflammatory drugs], and muscle relaxants if the pain continues."
Although inflammatory bowel disease (IBD) can be extremely painful, narcotics are inadvisable for this condition. Even so, a sizeable proportion of patients are inappropriately prescribed these drugs, according to one of the first surveys to quantify narcotic use among patients with IBD, presented here at Digestive Disease Week 2010.
"Narcotics use is exceedingly common in patients with IBD. Why should we worry? We should worry for a lot of reasons: first, these drugs do not help noncancer patients' bowel function; second, they carry a risk of drug dependency; and third, they may actually worsen symptoms of IBD," stated Spencer D. Dorn, MD, assistant professor of medicine at the University of North Carolina in Chapel Hill.
He described a newly identified condition called narcotic bowel syndrome, in which narcotics paradoxically increase abdominal pain, particularly at higher doses.
An Internet-based survey was sent to nearly 1800 patients who had seen a physician for irritable bowel syndrome (IBS) as defined by Rome III criteria. The researchers examined demographics, clinical characteristics, clinical features (including subtype, duration, and severity), most troublesome symptom, quality of life, psychological factors (such as anxiety and depression), overall satisfaction with care, and current medications.
In all, 325 adult patients (18%) reported current use of narcotics (excluding tincture of opiate, prescribed as an antidiarrheal medication).
Dr. Dorn said that patients who used narcotics had more severe IBS and worse physical and mental health than those who did not. Significant predictors of narcotic use included poor self-rated health (P < .0001), pain as the most bothersome symptom (P < .0001), number of bothersome symptoms (P = .008), number of hospitalizations (P < .01), number of lifetime surgeries (P < .0001), current antidepressant use (P = .01), current anxiolytic use (P < .02), and current antiacid use (P = .01).
Dr. Dorn and colleagues recommend a multidisciplinary approach to the management of IBS, which emphasizes patient education, self-management over time, nonnarcotic symptom-based therapies and, in some cases, antidepressants and/or psychotherapy.
Such an approach is challenging in the current healthcare environment, he acknowledged. "Clinicians often lack the time, infrastructure, and incentives needed to provide this type of care to patients with IBD and other chronic conditions. Instead, they often take the path of least resistance. Narcotic prescriptions are a quick and easy way to get patients out of their offices, even though the long-term effects can be harmful."
Dr. Dorn told meeting attendees that this study did not quantify recreational narcotic use — only narcotic prescriptions. He also pointed out that although the United States comprises only 4% of the world's population, our country accounts for more than 80% of narcotics prescribed worldwide.
Commenting on this presentation, moderator Deborah Proctor, MD, professor of medicine and medical director of the IBD Program at Yale University in New Haven, Connecticut, said that "gastroenterologists and other doctors who treat patients with IBD should rethink prescribing narcotics. Instead, they should first try [nonsteroidal anti-inflammatory drugs], and muscle relaxants if the pain continues."
