Chronic opioid use is associated with a nearly 2-fold increased risk for hospital-diagnosed infections and mortality.
Chronic opioid use (COU) is associated with an increased risk for infection and death among patients with inflammatory bowel diseases (IBD), according to study results published in Inflammatory Bowel Diseases
Researchers reviewed data from health registries (January 2000-June 2023) for patients with IBD aged 18 years and older. COU was defined as having 3 or more opioid prescriptions within a 12-month period and 30 days or more between each prescription
Outcomes were first hospital-diagnosed infection, first filled prescriptions of systemic antimicrobial agents (systemic antibiotics, antivirals, and antifungals), and death of any cause. A Cox proportional hazard regression model was used to assess the association between COU and outcomes. The time at risk was from initial IBD diagnosis until an outcome or emigration, death, or end of follow-up in March 2025
Patients with IBD and COU should be considered highly vulnerable, and early and increased vigilance of infectious complications are indicated to reduce further harm
The population included 18,897 patients with CD, of whom 3948 (20.9%) had COU. The patients with COU were more commonly women (64.4% vs 53.4%) and had more comorbid diseases compared with those without COU. Of those with COU, 38.9% were aged 31 to 50 years at initial IBD diagnosis, and 49.4% of those without COU were aged 18 to 30 years at first IBD diagnosis
In the COU group with CD, adjusted hazard ratios (aHRs) for hospital-diagnosed infections, prescribed systemic antimicrobial agents, and death were 1.91 (95% CI, 1.79-2.04), 1.47 (95% CI, 1.40-1.56), and 1.76 (95% CI, 1.58-1.96), respectively. The following aHRs also were observed: respiratory infections, 1.99 (95% CI, 1.80-2.18); gastrointestinal infections, 1.98 (95% CI, 1.78-2.20); urinary infections, 1.81 (95% CI, 1.60-2.05); skin/subcutaneous tissue infections, 2.07 (95% CI, 1.86-2.32); sepsis, 3.35 (95% CI, 2.86-3.92); and other infections, 2.09 (95% CI, 1.86-2.36).
The UC cohort included 32,947 patients, of whom 4779 (14.5%) had COU. The individuals with COU were more frequently women (59.2% vs 50.2%) and had more comorbid diseases, compared with patients without COU. In the COU group, 49.8% were aged older than 50 years at initial IBD diagnosis, and 38.7% without COU were aged 31 to 50 years at first IBD diagnosis
In the COU group with UC, aHRs for hospital-diagnosed infections, prescribed systemic antimicrobial agents, and death were 1.93 (95% CI, 1.80-2.06), 1.56 (95% CI, 1.47-1.65), and 1.74 (95% CI, 1.60-1.90), respectively. The aHR for respiratory infections was 1.97 (95% CI, 1.80-2.16), 2.43 (95% CI, 2.18- 2.70) for gastrointestinal infections, 2.15 (95% CI, 1.92-2.40) for urinary infections, 2.07 (95% CI, 1.83-2.34) for skin/subcutaneous tissue infections, 2.27 (95% CI, 1.92- 2.69) for sepsis, and 2.25 (95% CI, 2.00-2.54) for other infections.
In patients with only chronic strong opioid use, aHRs for hospital-diagnosed infections, prescribed systemic antimicrobial agents, and death were 2.36 (95% CI, 2.07-2.69), 1.50 (95% CI, 1.33-1.68), and 3.27 (95% CI, 2.84- 3.76), respectively. For those with only chronic weak opioid use, aHRs for hospital-diagnosed infections, prescribed systemic antimicrobial agents, and death were 1.54 (95% CI, 1.41-1.68), 1.42 (95% CI, 1.33-1.52), and 1.20 (95% CI, 1.04-1.40), respectively
The study was limited by its nonrandomized design, and information was not available for medical indications of prescriptions, treatment duration, and causes of death
“Patients with IBD and COU should be considered highly vulnerable, and early and increased vigilance of infectious complications are indicated to reduce further harm,” the researchers stated
Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures
This article originally appeared on Gastroenterology Advisor
Nørgård BM, Zeiss KE, Dalal RS, et al.Chronic opioid use and the risk of infections and death in patients with inflammatory bowel disease: a nationwide cohort study based on real-world data.Inflamm Bowel Dis.Published online May 31, 2026. doi:10.1093/ibd/izag085
