Evaluation of opioid use in acute pancreatitis in absence of chronic pancreatitis: Absence of opioid dependence an important feature

ABSTRACT INTRODUCTION Chronic opioid use and dependence is common in chronic pancreatitis. Patients with acute pancreatitis are frequently treated with opioids, but their risk for ongoing use is not well known. The aim of our study is to characterize opioid use in patients after an episode of acute pancreatitis, and to assess persistent, chronic and daily opioid use in such patients, in absence of chronic pancreatitis. METHODS This is a single center review of prospectively enrolled patients with acute pancreatitis. Using Massachusetts Prescription Awareness Tool we recorded all opioid prescriptions (frequency, duration and amount) for patients from December 2016 – September 2019, after index hospitalization for acute pancreatitis. Patients with chronic pancreatitis were excluded. We used univariate and multivariate analysis to determine predictors of opioid use at discharge, and subsequent follow-up over 18 months. RESULTS Of 235 opioid-naive patients enrolled, 123 patients (52.3%) received opioids at discharge after index hospitalization. In follow-up over 18 months, 40 patients (17.0%) received additional opioid prescriptions. These patients had more severe disease, longer length of stay and higher pain score at discharge. Patients with prior history of acute pancreatitis, local complications and higher pain scores were twice as likely to be prescribed opioids subsequently. Persistent opioid use was seen only in recurrent acute pancreatitis. There was no daily or chronic use. CONCLUSIONS In the absence of chronic pancreatitis, there was no daily or chronic use of opioids in acute pancreatitis. Persistent use was only seen in recurrent acute pancreatitis. These patients are at increased risk of chronic opioid use and dependence.