Journal Article

787 Addiction Medicine Consultation Reduces Narcotic Use and ER Visits and Increases Smoking Cessation in IBD Patients: A Cross-Sectional Study

Mullins, Selina, Kudaravalli, Praneeth, Kindred, Michael, Barrett, Terrence, Akanbi, Olalekan, Abomhya, Ahmed Abdelsatar, Perry, Courtney, Michailidis, Lamprinos, Tripathi, Nishant, Yarra, Pradeep

2019

Overview

INTRODUCTION:Inflammatory bowel disease (IBD) patients are chronically prescribed narcotics for chronic relapsing abdominal pain. We previously reported that emergency room (ER) visits in IBD patients increase the risk for chronic opioid use (COU - defined as 90 days of opioid use in a 6-month period) (Pauley et al Infl Bowel Dis 2017). Here we examine if referral to addiction medicine therapy reduces opioid prescriptions as well as ER visits.METHODS:IBD patients seen in the University of Kentucky out-patient GI clinic between January 2013 and November 2018 with COU were identified. Referrals to addiction medicine were identified by ICD 9/10 billing codes. EMRs of all study patients were retrospectively examined to collect data. Paired samples t-test was performed for outcomes 1 yr before and after addiction medicine consultation. All the statistical analysis was performed using SPSS Version 25 software; an alpha level of .05 was used throughout.RESULTS:During the 6-yr period, 2296 IBD patients on narcotics were identified. Among those 77 patients received addiction medicine referral, 36 patients complied. Mean age of the study population was 43 yrs. ER visits were reduced by 0.53 ± 0.24 visits in the year after consultation (mean ± SEM, 95% CI: 0.007–1.09; P < 0.04). Opioid prescriptions after addiction medicine consultation were also reduced by 0.37 ± 0.38 (P = 0.31). Substance abuse and mental health illnesses such as smoking, alcohol, illicit drug use, mood disorders and anxiety was seen in 72.2%, 22.2%, 19.4%, 27.8% and 16.7% of patients, respectively. Mean number of addiction medicine visits for tobacco and opioid abuse disorders were 2.2 and 5.3 respectively. Smoking cessation was successful in 11.5% of patients at 1 yr. However, a substantial reduction in smoking was noted in 26.9% of patients.CONCLUSION:Substance abuse and chronic opioids are factors known to be associated with worse outcomes in IBD patients. Our study shows IBD patients referred to addiction medicine service had significantly lower ER visits and trended to have fewer numbers of opioid prescriptions. Addiction medicine referrals were also successful in reducing smoking use by 27% with 11% cessation. Results reported here encourage further testing in larger sample sizes and suggest the implementation of addiction medicine professionals in the care of IBD patients.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Addictions / Drug abuse / Inflammatory bowel disease / Medicine / Narcotics / Smoking cessation