AIMS

Patients with inflammatory bowel disease (IBD) are at increased risk of substance use. Research on drug consumption in patients with IBD has primarily focused on use of individual substances. Little is known about polysubstance use (concurrent use of two or more drugs/substances of abuse) (PSU) in this context. We evaluated the incidence, predisposing factors and impacts of PSU in IBD.

METHODS

We performed a retrospective analysis using data from a single tertiary care referral center between 1/1/2015-8/31/2019. Demographics, clinical characteristics, and antidepressant or anxiolytic medication were abstracted. Associations between PSU, demographic and clinical characteristics were analyzed. Multivariable logistic regression models were fit incorporating significant clinical factors.

RESULTS

315 consecutively enrolled IBD patients (166 females, 149 males; 214 CD and 101 UC) were included. Sixty-six patients (21.0%) exhibited PSU (CD=21.8%, UC=19.8%). Of these patients, 40.9% had moderate to severe disease activity, 47.0% had extra-intestinal manifestations (EIMs), 36.4% demonstrated an anxious+/-depressed state, and 75.8% used healthcare resources (HRU) in the prior 12 months. 71.2% used two substances (alcohol+opioid=19.1%) while 27.3% used three substances (benzodiazepine+opioid+tobacco=22.2%). In the total cohort, EIMs (1.97; 1.14-3.34, p<0.05) and antidepressant/anxiolytic use (2.51; 1.45-4.39, p<0.001) were positively associated with PSU on multivariable analysis. PSU was associated with increased rates of IBD-associated imaging (57.6% vs. 47.0%, p<0.05).

CONCLUSIONS

PSU is common in IBD. EIMs and antidepressant/anxiolytic use were independently associated with PSU. PSU was associated with increased imaging. This study reinforces the importance of substance use screening in IBD, particularly among those with EIMs and antidepressant or anxiolytic use.

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