Prescription opioid use is common and associated with worse clinical outcomes in individuals with chronic liver disease

Background Prescription opioid use is highly prevalent and associated with increased morbidity and mortality. Clinical implications of use in chronic liver disease(CLD) remains poorly characterised. Aims Assess prevalence and clinical impact of opioid use in patients with CLD. Methods We conducted a retrospective cohort study using Marketscan to compare correlates and clinical outcomes of opioid use among patients with and without CLD. Patients were classified into categories based on opioid prescription claims in the 12-month period prior to index: non-use, naïve-use and prior-use. Multivariable logistic regression and Cox regression with a time-dependent covariate were used to assess correlates of opioid use and clinical outcomes including index hospitalisation, total admissions, hospital days, cost of hospitalisation and in-hospital mortality. Results Over a median follow-up of 38 (IQR 25-54) months among 587 445 adults (n = 71 402 CLD and 516 043 non-CLD), prescription opioid use (naïve-use and prior-use) was significantly higher among CLD than non-CLD patients (60% vs 41.8%, P < .001). Opioid exposure increased risk of clinical outcomes in both CLD and non-CLD patients (admissions IRR 2.71, 95% CI 2.67-2.76; hospital days IRR 3.00,95% CI 2.93-3.08; total cost IRR 3.13, 95% CI, 2.97-3.31; in-hospital mortality IRR 5.80, 95% CI 5.17-6.50). Associations between opiate use and clinical outcomes were greater among CLD than non-CLD patients (interaction P < .05 in each model). Conclusions Prescription opioid use is higher among patients with CLD and associated with higher rates, duration and cost of hospitalisation and in-hospital mortality. Interventions to curb opioid use in CLD are needed to improve healthcare utilisation and clinical outcomes.