Identifying and reducing opioid misuse among individuals with gastrointestinal disorders

Background. Individuals with gastrointestinal (GI) symptoms and disorders, including chronic abdominal pain, pancreatitis, and inflammatory bowel disease (IBD), are a subset of the population that may be uniquely affected by the national opioid epidemic. Individuals with these conditions frequently require pain therapy, with up to 43% using long-term opioids. Yet, long-term opioid use in GI care raises several patient safety concerns. High rates of opioid misuse have been documented in this population. Moreover, prolonged opioid use can lead to serious adverse events that paradoxically worsen GI symptoms, including bowel dysfunction and abdominal pain. Ultimately, long-term opioid therapy in GI care may lead to opioid misuse, abuse, and the risk of dangerous adverse events. We conducted a systematic scoping review to evaluate existing strategies to identify and reduce opioid misuse among individuals with GI symptoms and disorders. Methods. We performed structured keyword searches to identify manuscripts published through July 2016 in the PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases to extract original research articles that described health care practices, tools or interventions to identify and reduce opioid misuse, abuse or overuse among individuals with GI symptoms and disorders. Two reviewers independently screened all titles and abstracts; study eligibility was determined by consensus. Articles went through independent full-text reviews by the reviewers if the abstracts aligned with inclusion criteria. Results. Of the 3,236 articles retrieved from the search, twelve met inclusion criteria. These focused on individuals with abdominal pain, chronic pancreatitis, gastrointestinal surgical procedures, IBD, narcotic bowel syndrome, and pelvic pain. A majority of studies were quasi-experimental or retrospective chart reviews; the remaining studies included case reports, retrospective cohort studies, and descriptive, cross-sectional studies. Seven studies involved identification of opioid misuse through prescription drug monitoring and opioid misuse screening tools. Four studies discussed reductions in opioid use by harnessing drug monitoring data and individual care plans, and implementing self-management and opioid detoxification interventions. One study described use of drug monitoring data and an audit-and-feedback intervention to both identify and reduce opioid misuse. The greatest reductions in opioid misuse were observed when drug monitoring, self-management, or audit-and-feedback interventions were used. Conclusions. Few published studies have described strategies to reduce opioid misuse among individuals with GI symptoms and disorders. monitoring, self-management, and audit-and-feedback interventions may be promising strategies to enhance patient safety in this area. Rigorous, empirical research is needed to evaluate the longer-term impact of these patient safety strategies.