High-dose opioid use among adolescents and young adults with chronic digestive disorders

Background: High-dose opioid use (≥50 morphine milligram equivalents [MME]/day) is associated with increased risk of adverse outcomes, including overdose. We investigated the prevalence and risk factors for high-dose opioid use among adolescents and young adults (AYA) with inflammatory bowel disease (IBD) and other chronic digestive disorders to inform safer pain management strategies. Methods: This retrospective cohort study identified AYA aged 15–29 years with chronic digestive disorders who received ≥1 outpatient opioid prescription between March 2018–December 2021, using Northwestern Medicine’s Electronic Data Warehouse. Short-term persistent high-dose opioid use was defined as a daily mean of ≥50 MME/day for ≥7 consecutive days. Patients were categorized into high-dose vs. non-high-dose users. We examined demographic and clinical covariates (e.g., race/ethnicity, insurance status, psychiatric diagnoses, GI and non-GI pain diagnoses, concurrent medications) using descriptive and bivariate analyses. Risk factors for high-dose use were identified via multivariate logistic regression. Results: Among 2,549 AYA patients, 12% met criteria for high-dose opioid use. Risk factors included older age within the cohort, benzodiazepine-opioid co-use, oxycodone prescriptions, and concurrent non-GI pain diagnoses (e.g., arthritis). Discussion: Nearly 12% of AYA with chronic digestive disorders who used opioids for ≥7 days received high-dose prescriptions. These findings underscore the need for safer prescribing guidelines tailored to this population. Future work should consider weight-based dosing thresholds and expanded datasets to reduce opioid-related harm in AYA with digestive disorders.