Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015

Abstract

Background: Opioids are commonly prescribed for relief in inflammatory bowel disease (IBD). Emerging evidence suggests that adolescents and young adults are a vulnerable population at particular risk of becoming chronic opioid users and experiencing adverse effects.

Objectives: This study evaluates trends in the prevalence and persistence of chronic opioid therapy in adolescents and young adults with IBD in the United States.

Method: A longitudinal retrospective cohort analysis was conducted with the Truven MarketScan Database from 2007 to 2015. Study subjects were 15-29 years old with ≥2 IBD diagnoses (Crohn's: 555/K50; ulcerative colitis: 556/K51). Opioid therapy was identified with prescription claims within the Truven therapeutic class 60: opioid agonists. Persistence of opioid use was evaluated by survival analysis for patients who remained in the database for at least 3 years following index chronic opioid therapy use.

Results: In a cohort containing 93,668 patients, 18.2% received chronic opioid therapy. The annual prevalence of chronic opioid therapy increased from 9.3% in 2007 to 10.8% in 2015 (P < 0.01), peaking at 12.2% in 2011. Opioid prescriptions per patient per year were stable (approximately 5). Post hoc Poisson regression analyses demonstrated that the number of opioid pills dispensed per year increased with age and was higher among males. Among the 2503 patients receiving chronic opioid therapy and followed longitudinally, 30.5% were maintained on chronic opioid therapy for 2 years, and 5.3% for all 4 years.

Conclusion: Sustained chronic opioid use in adolescents and young adults with IBD is increasingly common, underscoring the need for screening and intervention for this vulnerable population.

FIGURE 1.

Study population selection. This flow diagram outlines the study population selection in the Truven MarketScan Database. It demonstrates step by step how the chronic opioid therapy sample was created.

FIGURE 2.

Prevalence of chronic opioid therapy. The prevalence of chronic opioid therapy among adolescents and young adults with IBD between 2007 and 2015 was calculated using the Truven MarketScan Database. The proportion of individuals meeting criteria for chronic opioid therapy increased from 9.3% in 2007 to a peak of 12.2% in 2011, then declined to 10.8% in 2015 (P < 0.01).

FIGURE 3.

Persistence of chronic opioid therapy. Kaplan-Meier analyses were conducted to determine persistence of chronic opioid therapy for adolescents and young adults with IBD who filled ≥2 opioid prescriptions in an index year and remained in the database for ≥3 subsequent years. Analyses showed that 30.5% continued to receive chronic opioid therapy in year 2, 10.7% in year 3, and 5.3% in year 4.