Q&A: Managing Substance Abuse Among Patients With CD

Photo Credit: Bet_Noire

Charles Berstein, MD, discusses the challenges linked to managing substance abuse among patients with Crohn’s Disease.

According to research, substance use disorders (SUDs) cause significant individual and societal burdens, but their prevalence and associated factors in people with inflammatory bowel disease (IBD) are largely unknown. Charles Bernstein, MD, and colleagues found one in six patients with IBD experienced an SUD.

To better understand SUD in Crohn’s Disease (CD), Physician’s Weekly (PW) spoke with Dr. Bernstein.

PW: How common are issues related to substance use among patients with CD?

Dr. Bernstein: I think this may be different in different populations—ie Canada versus China.  However, we have reported in a paper in IBDJ 2020 that one in six people with IBD met the criteria for a lifetime diagnosis of SUD. This is like rheumatoid arthritis, where we reported a lifetime prevalence of substance use disorder of one in seven patients.

What role do you believe a gastroenterologist should play in educating patients with CD about the risks associated with substance use?

A large role. We have shown that being depressed is a predictor for high dose, long-term opioid use, and being a smoker is a predictor for having a substance use disorder. I strongly believe gastroenterologists should be discussing smoking and mental health with all their patients.

These are two issues that can have an impact on disease course (smoking in relation to CD) and mental health disorder in relation to symptoms and outcomes in both CD and ulcerative colitis. If a patient has an active substance use disorder, this will impact their ability to adhere to medical advice and medicines as they experience symptoms. Hence, gastroenterologists should be inquiring about substance use and be aware of where to refer patients who want help with quitting.

How do you or how can others collaborate with other healthcare professionals (eg, primary care physicians, addiction specialists) in managing substance use among your patients with CD?

I refer patients to addiction specialists when I am aware it is an issue. Of course, I only attempt this if the patients acknowledge the issue and want help quitting. I communicate with primary care physicians about all aspects of a patient with IBD, including their mental health, substance use, and GI symptoms.

What are common challenges in managing substance abuse among patients with CD?

When the patient attempts to use their diagnosis as a crutch to obtain narcotics when they appear in a clinic or ER.  Too often, patients are given short courses of narcotics because they report

pain. Narcotics never cure a patient of pain, and they are ultimately gateways to higher doses of narcotics and other illicit drugs.

In your opinion, how big or small should the role of a gastroenterologist be in managing substance abuse in patients with CD?

The key role is to help recognize it when it exists and encourage the patient to get help while referring them to the appropriate specialist. Also, to point out to patients what the issues are with ongoing substance abuse in managing their IBD.

What changes or improvements would you like to see in the future to better equip gastroenterologists in dealing with substance use among patients with CD?

Ensuring gastroenterologists are more comfortable discussing psychosocial issues—it is not all about scoping!

How important is interdisciplinary collaboration in managing substance use in patients with CD, and how do you facilitate it?

Very important. Healthcare professionals can facilitate it by engaging with other practitioners, including inviting them to meetings to collaborate on research and to set up specialty clinics.