title: Prevalence of chronic narcotic use among children with inflammatory bowel disease.
abstract: OBJECTIVE
  Narcotic analgesics are not recommended for long-term management of pain for patients with inflammatory bowel disease (IBD), particularly pediatric patients. We compared chronic use of narcotics among children with IBD and the general population and investigated factors associated with narcotic use in the pediatric IBD population.
  
  
  METHODS
  This cross-sectional study included children (younger than 18 years old) with continuous enrollment in a large administrative claims database from 2010 through 2011 (n = 4,911,286). Children with IBD were identified through diagnosis codes and dispensation of IBD medication (n = 4344); they were matched for age, sex, and region with 5 children without IBD (n = 21,720). Chronic narcotic use was defined as ≥3 dispensements of narcotics. We estimated prevalence odds ratios (PORs) and 95% confidence intervals (CIs), comparing narcotic use on the basis of IBD status and evaluating variables associated with narcotic use by patients with IBD by using conditional and unconditional logistic regression.
  
  
  RESULTS
  The prevalence of chronic narcotic use was 5.6% among children with IBD vs 2.3% in the general population (POR, 2.6; 95% CI, 2.2-3.0). Compared with the general population, POR for chronic narcotic use was significantly higher for pediatric IBD patients with psychological impairment (POR, 6.8; 95% CI, 4.3-10.6) than those without (POR, 2.3; 95% CI, 1.9-2.7). Older age, increased healthcare utilization, fracture, and psychological impairment were strongly associated with chronic use of narcotics among children with IBD.
  
  
  CONCLUSIONS
  Chronic narcotic use is common in pediatric IBD patients, particularly among those with anxiety and depression. Increased awareness of psychological comorbidity, screening, and treatment may reduce symptoms that lead to narcotic use and its complications.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, Chapel Hill, North Carolina. Electronic address: jessbuck@unc.edu.
authors.forename: Jessie P
authors.initials: JP
authors.lastname: Buckley
authors.affiliation: Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, Chapel Hill, North Carolina.
authors.forename: Suzanne F
authors.initials: SF
authors.lastname: Cook
authors.affiliation: Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, Chapel Hill, North Carolina.
authors.forename: Jeffery K
authors.initials: JK
authors.lastname: Allen
authors.affiliation: Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D009294:Narcotics / Q000008:administration & dosage*; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D009294:Narcotics
keywords: CD; Crohn’s Disease; UC; Ulcerative Colitis