Higher Prescribed Opioid Use Among Adults With Crohn's Disease Than General Population: A Nationwide Cohort Study in Sweden 2006-2021

Abstract

Background and aims: Population-based data on prescribed opioid use among adults with Crohn's disease (CD) remain limited.

Methods: This nationwide register-based study included individuals ≥ 18 years with incident (2008-2019) or prevalent (2008-2021) CD and up to 10 individually matched reference individuals without inflammatory bowel disease. We categorised opioid dispensations as weak (e.g., tramadol) or strong (e.g., oxycodone). We calculated the prevalence of ≥ 1 dispensation and mean daily doses (MDD) of opioids per 6 month period from 2 years before until 5 years following CD diagnosis (for incident cohort) and annual dispensation and MDD of opioids (for prevalent cohort).

Results: Among 10,527 patients with incident CD and 96,123 references, opioid dispensations were two-fold among patients 2 years before diagnosis (26.2% vs. 12.6%) and remained high 13-36 months after diagnosis (26.5% vs. 11.7%). In the prevalent cohort (32,306 patients and 289,516 reference individuals), there was a declining trend in the use of dispensed opioids. During observation, the use of weak opioids decreased substantially among individuals with CD (16.0% vs. 6.0%) and reference individuals (8.0% vs. 3.0%). However, opioid MDD only decreased substantially among those with CD between 2008 and 2021.

Conclusion: Adults with incident CD had a two-fold higher use of dispensed opioids than references 2 years before diagnosis, which peaked at three- and four-fold higher use around diagnosis and remained high for 3-5 years. The decreased use of weak opioids might explain the recent decline in opioid consumption among patients with CD.

Keywords: Crohn's disease; incidence; opioid use; time trend.

FIGURE 1

Prevalence of opioid use among individuals with incident Crohn's disease (CD) diagnosed between 2008 and 2019, and their matched reference individuals 2006–2021. Data are weighted based on the strata size of each matched set and presented in 6 month intervals, spanning from 2 years before to 5 years after the first CD diagnosis.

FIGURE 2

Prevalence of using weak (panel a) or strong (panel b) opioids among adults with Crohn's disease (CD) diagnosed 2008–2019. Data are weighted based on the strata size of each matched set and presented in 6 month intervals, spanning from 2 years before to 5 years after the first CD diagnosis.

FIGURE 3

Mean Daily Dose (MDD) of dispensed opioids (in milligrams) among adults diagnosed with Crohn's disease (CD) between 2008 and 2019, and their matched reference individuals. Opioid use is tracked in 6 month intervals from 2 years before to 5 years after the index date (first CD diagnosis), using data from Sweden (2006–2021). Panel a includes all study participants, with MDD estimates for reference individuals weighted according to the strata size of their matched set. History of opioid use in the 24 months prior to the index date is categorised as: Non‐users (no filled prescriptions), intermittent users (≥ 1 filled prescription in 1–3 of the 6 month periods) and persistent users (≥ 1 filled prescription in all four 6 month periods). Panels b, c and d display stratified analyses based on this history of opioid use. In these panels, MDD estimates for reference individuals are standardised to the age and sex distribution of participants with CD in the corresponding subgroup: Panel b shows non‐users, Panel c intermittent users and Panel d persistent users.

FIGURE 4

Annual prevalence of having ≥ 1 dispensed opioid prescription among adults with a prevalent Crohn's disease (CD) diagnosis and their matched reference individuals in Sweden, 2008–2021. Reference individuals were matched on sex, birth year, diagnosis year and residential location at the time of diagnosis. Joinpoint regression was used to estimate the Annual Percent Change (APC) in opioid use prevalence. To maintain balance between groups over the study period, prevalence estimates for reference individuals were weighted according to the strata size of their matched set for each calendar year.

FIGURE 5

Mean daily dose (MDD) of dispensed opioids (in milligrams), with 95% confidence intervals, among adults with a prevalent Crohn's disease (CD) diagnosis and their matched reference individuals in Sweden, 2008–2021. Reference individuals were matched on sex, birth year, diagnosis year and residential location at the time of diagnosis. MDD was calculated as the total annual prescribed opioid dose per person divided by 365 days. To ensure comparability between groups across calendar years, MDD estimates for reference individuals were weighted according to the strata size of their matched set in each year.