Prescribing Narcotic Analgesics to Children with IBD

Inflammatory bowel disease (IBD) is a term that primarily refers to two diseases of the intestines: Crohn’s disease and ulcerative colitis. These diseases cause chronic inflammation, and include symptoms such as severe abdominal pain, diarrhea, and rectal bleeding. A diagnosis of Crohn’s disease or ulcerative colitis can occur at any point throughout life. However, the peak age-specific diagnosis occurs between 10 and 20 years of age, and a second smaller peak occurs around 50 years of age.

There is no cure for IBD, so treatment typically involves managing symptoms. Since mild to severe abdominal pain is very common in IBD, physicians sometimes prescribe narcotic analgesics as a treatment for this symptom. However, there are many complications with long-term use of these drugs, including adverse effects on the gastrointestinal tract and psychological or physical dependence.1,2

In children, chronic treatment with narcotics can also cause malnutrition, failure to grow properly, opportunistic infections, and hepatosplenic lymphoma.1 However, despite these risks, new research findings show that physicians prescribe narcotics to children with IBD pain at double the rate of children without IBD, who have pain.1 They prescribe these medications even more frequently to children with IBD who also already have anxiety or depression.1

In a study recently published in Clinical Gastroenterology and Hepatology, researchers compared chronic prescribing of narcotics to children with IBD and children without IBD and analyzed associated factors. This is the first scientific study published in a medical journal that evaluated prescribed narcotic use in children with IBD.

The study consisted of 4,344 children with IBD (63% Crohn’s disease, 37% ulcerative colitis) and 21,720 children without IBD. They excluded any children who underwent gastrointestinal surgery during the study period.

The researchers classified the children who had at least three narcotic prescriptions filled between 2010 and 2012 as chronic users. During the study period, 5.6% of children with IBD and 2.6% of children without IBD met these criteria for chronic narcotic use.1 The rate of narcotic usage was about the same for and Crohn’s disease (5.6%) and ulcerative colitis (5.5%).1

The most common factors associated with chronic narcotic use in children with IBD were age, anxiety, and depression. Children who had IBD along with anxiety or depression had the highest rates of narcotic prescription use at 12.5% and 14.4% respectively. This is especially interesting since in the children without IBD, having anxiety or depression only increases their rates of narcotic use by a very small amount, but in the children with IBD the rate of narcotic use more than doubles.

This study shows that even though long-term narcotic prescription use is associated with gastrointestinal complications and external intestinal symptoms, prolonged use of narcotic analgesics is not uncommon among children with IBD.

Prior research has shown that individuals with IBD are more prone to depression and anxiety than those without the disease.3 This could mean that a large group of children with IBD are at risk of becoming chronic narcotic users.

One of the study authors suggests that, “increased awareness of psychological comorbidity, screening, and treatment may reduce symptoms leading to narcotic use and disease complications that are due to narcotic use.”1

If you are caring for a child who has IBD and taking narcotics for chronic pain, you may wish to discuss this research with your child’s specialist.

First published in the Inside Tract® newsletter issue 196 – 2015
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1. Buckley J et al. Prevalence of chronic narcotic use among children with inflammatory bowel disease. Clinical Gastroenterology and Hepatology. 2015;13(2):310-315.
2. Jones JL et al. Avoiding the vicious cycle of prolonged opioid use in Crohn’s disease. American Journal Gastroenterology. 2005;100(10):2230-2232.
3. Loftus EV Jr. et al. Increased risks of developing anxiety and depression in young patients with Crohn’s disease. American Journal of Gastroenterology. 2011;106(9):1670-1677.