Both psychiatric disorders and functional gastrointestinal disorders (FGID) have been shown to be prevalent among patients with inflammatory bowel disease (IBD) and chronic narcotic use. IBS-like symptoms have been found to be 2 to 3 times more prevalent in patients with IBD in remission than in the general population. In a prior study, we demonstrated that FGID was a major risk factor for chronic narcotic use and prescription narcotic misuse among patients with Crohn's disease (CD), representing a 2-fold and 3-fold increased risk for development, respectively. Other studies have demonstrated that risk for chronic narcotic use for non-organic disease is higher among patients with CD rather than ulcerative colitis (UC). To our knowledge, rates of chronic narcotic use and misuse among patients with ulcerative colitis have not been studied extensively. In this study, we aimed to determine whether the presence of a concomitant functional gastrointestinal disorder (FGID) affected rates of chronic narcotic use and misuse in UC patients.Methods:
A retrospective chart review of ulcerative colitis patients seen at the University of Virginia Digestive Health outpatient clinic from 2006 to 2011 was performed. Patient demographics, including concurrent FGID and psychiatric histories, were obtained from the electronic medical record. The Virginia and West Virginia prescription monitoring programs (PMPs) were accessed to obtain prescription narcotic filling histories. Chronic narcotic use was defined as having 3 consecutive prescriptions for narcotics filled or having 2 or more narcotic prescriptions filled within a 6-month period. Narcotic misuse was defined as the use of greater than or equal to 4 pharmacies or 4 prescribers of schedule II medications within a 12-month period.Results:
A total of 497 patients with ulcerative colitis were included in the analysis. Thirty-nine (7.8%) patients were identified as having concurrent FGID. Of the patients who had FGID, a greater proportion was found to be using narcotics chronically (36% with FGID versus 9% without FGID, P = 0.011). FGID was associated with female gender, but was not significantly associated with age, disability, alcohol or tobacco use, or depression. Five of 39 (12.8%) UC patients with FGID were misusing prescription narcotics, compared with 6 of 458 (1.3%) UC patients without FGID (P = 0.0008). Multivariate logistic regression demonstrated a significant association between FGID and chronic narcotic use (OR = 3.55, 95% confidence interval, 1.33–9.48) after controlling for other variables, and a significant association was also seen between FGID and narcotic misuse (OR = 11.0784, 95% CI, 3.22–38.17).Conclusions:
Functional GI disease is common in patients with ulcerative colitis, and is associated with a 3.5-fold increased risk of chronic narcotic use and an 11-fold increased risk of narcotic misuse in this patient population. Prescription monitoring programs can help identify ulcerative colitis patients at risk of narcotic misuse, and selective screening of patients with FGID can be considered.