Teens With Inflammatory Bowel Disease at Higher Risk for Opioid Abuse
Recurring opioid painkiller use is relatively common in teenagers with inflammatory bowel disease, especially among those individuals who also have substantial indications of mental health problems, according to findings from a team of U.S. researchers.
Inflammatory bowel disease (IBD) is the collective name for a group of conditions that produce serious and ongoing inflammation in the digestive tract. In a study published in February 2015 in the journal Clinical Gastroenterology and Hepatology, researchers from two U.S. institutions looked at the frequency of prescription opioid use among teenagers and younger children diagnosed with IBD. The researchers concluded that recurring opioid medication use in these age groups is unusually common, even though current guidelines do not support the ongoing use of opioids for IBD treatment.
Inflammatory Bowel Disease
Two main conditions fall under the heading of inflammatory bowel disease: Crohn’s disease and ulcerative colitis. People with Crohn’s disease develop chronic inflammation in the linings of their small intestines and/or their colons (large intestines). In many cases, lining inflammation eventually penetrates to deeper levels of digestive tract tissue. People with ulcerative colitis experience a combination of ulcer development and chronic inflammation in the deeper layers of the linings in their colons and rectums. Two other conditions—lymphocytic colitis and collagenous colitis—are also sometimes included in the IBD category, although they differ from both Crohn’s disease and ulcerative colitis in important ways.
No one knows precisely why inflammatory bowel disease occurs in any given person, although genetic predisposition and a dysfunctional immune system may each play a role in some cases. Known risk factors for IBD include being age 29 or younger, having a close family member with IBD, using cigarettes, living in a city and having a Caucasian or Ashkenazi Jewish racial/ethnic background. Doctors can use a range of medications to treat the symptoms of inflammatory bowel disease, including corticosteroids and other anti-inflammatories, antibiotics and immune system suppressors. In some cases, acetaminophen is used to ease the pain associated with IBD. However, opioid medications do not appear on the list of generally used medications for IBD-related conditions.
Teenagers and Prescription Opioid Abuse/Misuse
Every year, the National Institute on Drug Abuse uses data from a nationally representative, University of Michigan-led project called Monitoring the Future to track the number of teenagers in America who inappropriately consume two well-known opioid medications: Vicodin (which contains an opioid substance called hydrocodone) and OxyContin (which contains another opioid substance called oxycodone). In 2014, 4.8 percent of the nation’s 12th graders used Vicodin inappropriately at least once, while 3.3 percent misused OxyContin. Among 10th graders, the annual rates of Vicodin and OxyContin misuse were 3.4 percent and 3 percent, respectively. Among eighth graders, the annual rate of abuse/misuse for both Vicodin and OxyContin stood at 1 percent.
Opioid Use in Teens With IBD
In the study published in Clinical Gastroenterology and Hepatology, researchers from the University of North Carolina at Chapel Hill and the pharmaceutical company GlaxoSmithKline used hospital data from 4,344 children below the age of 18 to help determine how often teenagers and younger children with inflammatory bowel disease inappropriately and recurrently consume an opioid medication. All of the teens and younger children in this group had received an IBD diagnosis; the project also included a comparison group of 21,720 people in the same age range unaffected by IBD. The researchers set a threshold of three or more occasions of opioid medication use as the minimum standard for recurring or chronic opioid consumption.
After reviewing the data, the researchers concluded that roughly 5.6 percent of all teens and younger children with inflammatory bowel disease qualify as chronic opioid painkiller consumers, even though the use of these medications is inconsistent with the recommended course of treatment for their condition. In contrast, just 2.3 percent of teens and younger children in the general population use/misuse an opioid painkiller. When they further analyzed the available data, the researchers concluded that teenagers with IBD are substantially more likely to inappropriately consume an opioid medication if they have significant mental health issues (including symptoms of anxiety and/or depression). Other factors associated with an increased rate of use/misuse include being closer to age 18, having a broken bone and having a generally high rate of healthcare use.
The study’s authors believe that increased awareness of inappropriate opioid painkiller use among teens and younger children with IBD may help prevent opioid intake and the potential addiction-related and non-addiction related consequences of opioid intake in this age group.