The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy

Abstract

Background Suboptimal colon preparation is a significant barrier to quality colonoscopy. The impact of pharmacologic agents associated with gastrointestinal dysmotility on quality of colon preparation has not been well characterized. Aims Evaluate impact of opiate pain medication and psychoactive medications on colon preparation quality in outpatient undergoing colonoscopy. Methods Outpatients undergoing colonoscopy at a single medical center during a 6-month period were retrospectively identified. Demographics, clinical characteristics and pharmacy records were extracted from electronic medical records. Colon preparation adequacy was evaluated using a validated composite colon preparation score. Results 2600 patients (57.3±12.9 years, 57% female) met the inclusion and exclusion criteria. 223 (8.6%) patients were regularly using opioids, 92 antipsychotics, 83 tricyclic antidepressants and 421 non-tricyclic antidepressants. Opioid use was associated with inadequate colon preparation both with low dose (OR=1.4, 95%CI 1.0-2.1, p=0.05) and high dose opioid users (OR=1.7, 95%CI 1.1-2.9, p=0.039) in a dose dependent manner. Other significant predictors of inadequate colon preparation included use of tricyclics (OR=1.9, 95%CI 1.1-3.0, p=0.012), non-tricyclic antidepressants (OR=1.5, 95%CI 1.1-2.0, p=0.013), and antipsychotic medications (OR=2.2, 95%CI 1.4-3.4, p=0.001). Conclusions Opiate pain medication use independently predict inadequate quality colon preparation in a dose dependent fashion; furthermore psychoactive medications have even more prominent effects and further potentate the negative impact of opiates with concurrent use.

Impact of opioid use on patients undergoing screening colonoscopy according to the quality of bowel preparation

“…This study supports the results of previous studies showing the negative impact of opioid use on bowel preparation but also indicates that opioid use may be associated with more procedure‐related complications and slightly longer procedure times. These differences were generally relatively small.…”

“…Findings from previous studies support the association of opioid exposure and male gender with poor bowel preparation quality . In addition, the proportion of patients who were unexposed to opioids with adequate bowel preparation was comparable in this study (87.3%) with that reported in previous studies (75.6% and 90.7%) . In the current study, the use of opioids was also shown to have an impact on other colonoscopy outcomes, beyond the adequacy of bowel preparation.…”

“…Male gender was also independently associated with poorer bowel preparation quality prior to screening colonoscopy. Findings from previous studies support the association of opioid exposure and male gender with poor bowel preparation quality . In addition, the proportion of patients who were unexposed to opioids with adequate bowel preparation was comparable in this study (87.3%) with that reported in previous studies (75.6% and 90.7%) .…”

“…Based on these criteria, 7.4% of patients who had undergone screening colonoscopy were included in the opioid‐exposed group. This rate was comparable to that in a previous retrospective study of outpatients undergoing colonoscopy, in which 8.6% were identified as regular opioid users …”

“…Constipation has been reported in approximately 40–80% of patients taking opioids for chronic pain . Several large studies have shown that prior exposure to opioids (at both low and high doses) represents an independent risk factor for poor bowel preparation …”