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The impact of opioid use in chronic pancreatitis from 2004-2024: A propensity-matched analysis of 183,214 individuals.

Yassine Kilani,Mahmoud Y. Madi,Ayah Obeid,Farah Heis,Park， Jiwon,D. A. Gonzalez Mosquera,Tarek Nammour,A. Drewes,S. S. Olesen,Adam D. Farmer

Published 2025 in Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]

ABSTRACT

BACKGROUND Chronic pancreatitis is a progressive inflammatory disease causing exocrine and endocrine dysfunction, frequently leading to severe, recurrent pain necessitating treatment with opioid analgesics. The impact of opioid use on chronic pancreatitis outcomes is poorly understood. OBJECTIVE This study's objective was to evaluate the effect of opioid use on mortality and healthcare utilization in patients with chronic pancreatitis using real-world data. DESIGN We conducted a retrospective cohort study using the TriNetX research network, identifying U.S. adults (≥18 years) with chronic pancreatitis from a 121-million-patient database (2005-2025). Patients were stratified into opioid users and non-users (controls) and propensity score matched (1:1) for demographics, body mass index, comorbidities, laboratory parameters, and treatments. Primary outcomes included acute-on-chronic pancreatitis, all-cause mortality, emergency department (ED) visits and hospitalizations. Outcomes were analyzed using Cox regression and time-stratified methods, reported as adjusted hazard ratios (aHR). RESULTS Of 252,130 patients with chronic pancreatitis, 143,758 opioid users and 108,372 non-users were propensity-matched. Opioid users were older, with higher rates of alcohol use, pancreatitis risk factors, psychiatric disorders, substance use disorder, malnutrition, and analgesic use (all p < 0.0001). Opioids were associated with increased risks of acute-on-chronic pancreatitis (aHR = 1.45, 95 % CI: 1.36-1.54), all-cause mortality (aHR = 1.90, 95 % CI: 1.80-2.00), and ED visits (aHR = 1.28, 95 % CI: 1.22-1.36). CONCLUSION Opioid use in chronic pancreatitis is associated with higher morbidity, mortality, and healthcare utilization, likely reflecting underlying disease severity and complications. These patients represent a high-risk group warranting greater attention, and prospective studies are needed to clarify causal relationships and guide optimized pain management strategies.

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