Q&A: Part 1: Examining Substance Misuse in Crohn’s Disease

Photo Credit: Arvydas Lakacauskas

The limited data available shows that patients with Crohn’s disease may be more likely to misuse substances than the general population.

Patients with Crohn’s disease (CD) appear to engage in more substance use than the general population, according to findings published in Gastro Hep Advances.

In a retrospective cohort study of 37,323 Medicaid recipients with incident CD, Po-Hung (Victor) Chen, MD, PhD, and colleagues used diagnostic codes to identify patients who had newly diagnosed CD and had used alcohol, opioids, cocaine, amphetamine, or cannabis. The researchers used multivariable logistic regression to analyze associations between CD-related interventions and substance use after CD diagnosis.

Findings showed that 6,091 of Medicaid enrollees with incident CD (16.3%) had ever used substances. Alcohol and opioid use, at 8% each, were more frequent than previously reported for the general US population (6% and 4%, respectively, in 2019). Cannabis use was reported in 4.3%, cocaine in 2.3%, and amphetamine use in 1.3%.

In the first of this two-part series, Dr. Chen talked with Physician’s Weekly (PW) about how frequently substance misuse occurs in patients with CD and the link between the two conditions.

PW: Are patients with CD more likely than the general population to engage in substance use?

Dr. Chen: Existing data on the prevalence of substance misuse among patients with CD are quite limited, which was one reason we conducted our study. We found substance misuse in individuals with newly diagnosed CD to be generally more common than published estimates for the general US population in the same period.

However, findings across all substances were not uniform. Alcohol and opioid misuse seemed more common among individuals with CD than in the general population, while cannabis misuse was less commonly reported. In a separate analysis our team published on tobacco use in the same cohort, estimates for tobacco use were also higher than in the general US population.

Do the symptoms of CD lead to substance use to cope with symptoms, or does substance use play a role in the development of CD?

Symptoms of CD can lead to substance use as a coping strategy. Up to a quarter of patients with CD manifest depressive symptoms. Depression and other mental health conditions are well-described as associated cyclically with substance use disorders. Our findings also show that interventions that are more successful at improving CD symptoms are associated with reduced alcohol and opioid use.

I am only aware of scientific data supporting the notion that tobacco use may increase the risk for developing CD. Otherwise, I have not come across data to suggest that other substance use can cause CD in healthy individuals. However, studies point toward alcohol and opioids as worsening symptoms among individuals with established CD. Ethanol and other substances such as sulfites in alcohol-containing beverages may disrupt the gut mucosal barrier, causing more intestinal infections and pain. Similarly, opioids may cause bowel dysfunction such as constipation, bloating, and visceral hyperalgesia that worsen IBD-related symptoms.

Stay tuned for part 2 with Dr. Chen.