Prevalence of Opioid Use and Associated Healthcare Outcomes in Rome IV Irritable Bowel Syndrome in the United Kingdom

Background

The United Kingdom (UK) has one of the highest worldwide opioid prescription rates per capita. International guidelines caution against the use of opioids for chronic non-malignant pain, including irritable bowel syndrome (IBS).

Aims

To study the prevalence and impact of regular opioid use among people with Rome IV IBS in community settings in the UK.

Methods

We collected demographic, quality of life (QoL), psychological symptoms, and healthcare utilisation data from 752 people with Rome IV IBS. Participants were recruited via electronic mailshot in July 2021 through ContactME-IBS, a UK registry of persons diagnosed with IBS primarily by a general practitioner or gastroenterologist.

Results

Among participants, 148 (19.7%) reported taking an opioid regularly. The prevalence of opioid use did not vary across IBS subtypes (p = 0.10). Disease-specific and generic QoL were lower among opioid users than non-users (p < 0.001, both analyses). Compared with non-users, a greater proportion of opioid users had anxiety or depression (p < 0.001, both analyses) and greater overall activity impairment (p < 0.001). The direct healthcare costs related to investigations (p = 0.003), IBS-related medications (p < 0.001), and unplanned hospital attendances (p < 0.001) were greater among participants who used opioids. Opioid users also expressed a greater willingness to accept the risk of death in return for a cure of IBS symptoms from a hypothetical medication (p = 0.002).

Conclusion

Approximately one in five people with Rome IV IBS used opioids on a regular basis. Compared with non-users, opioid users had worse QoL, greater psychological impairment, and higher direct healthcare costs.