Polysubstance use in inflammatory bowel disease

Abstract

Objectives We aimed to evaluate the incidence, predisposing factors and impacts of polysubstance use (PSU) (ie, the concurrent use or abuse of two or more drugs or substances) in inflammatory bowel disease (IBD). Methods Data of patients enrolled between 1 January 2015 and 31 August 2019 from a single tertiary care referral center were retrospectively collected. Patients’ baseline and clinical characteristics and their antidepressant and/or anxiolytic medications were abstracted. Associations between PSU and patients’ characteristics were analyzed. Multivariate logistic regression models were fit, incorporating significant clinical factors. Results Altogether 315 patients with IBD (166 women, 149 men; 214 with Crohn's disease and 101 ulcerative colitis) were enrolled. Of them, 66 (21.0%) exhibited PSU (CD 21.5%, UC 19.8%); 37.5% had moderate to severe disease activity, 34.3% with extraintestinal manifestations (EIM), 41.6% with an anxious or depressed state and 69.8% had used healthcare resources in the prior 12 months. Moreover, 71.2% used two substances, while 27.3% used three substances. In the total cohort, EIM (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.14‐3.34, P = 0.019) and antidepressant or anxiolytic use (OR 2.51, 95% CI 1.45‐4.39, P < 0.001) were positively associated with PSU on multivariate analysis. PSU was associated with increased rate of IBD‐associated imaging (57.6% vs 47.0%, P < 0.05). Conclusions PSU is common in IBD. EIM, antidepressant and/or anxiolytic use and imaging studies were independently associated with PSU. This study reinforces the importance of screening patients with IBD for substance use, particularly those with EIM and using antidepressants and/or anxiolytics.

Substance Use Among Patients With Incident Crohn’s Disease in the United States, 2010 to 2019: A Medicaid Observational Study

“…This phenomenon may suggest that less individuals engaged in any alcohol or drug use after the CD diagnosis but polysubstance use became more common. The subgroup of patients with polysubstance use may share certain features (eg, extra-intestinal CD) 36 but future patient-level analyses are needed to test this theory.…”

Use of Benzodiazepines and Z-Drugs in Inflammatory Bowel Disease

“…Whether concomitant BZD use in some way worsens underlying depression leading to increased overdoses in opioid users or whether the concomitant use suggests these persons have more severe mental health disorders is not known. Beyond concomitant opioid use, in one study of 315 persons with IBD, the use of anxiolytics was one predictive factor of polysubstance use (41). Because BZDs are often coprescribed with opioids and any polydrug use contributes to ill health and adverse outcomes, it is important to define the degree of BZD use in the IBD population.…”