Iatrogenic physiologic opioid dependence masquerading as recurrent acute pancreatitis flares: case series

Patients with recurrent acute flares of pancreatitis—especially those receiving frequent opioid treatment for pain—can develop physiologic dependence to opioids. This can complicate the clinical picture, making it difficult to distinguish between true pancreatitis flares and opioid withdrawal presenting with similar symptoms. We describe two cases of patients admitted recurrently for pancreatitis: a 24-year-old Haitian male with alcohol use disorder, and a 37-year-old Indian female with hypertriglyceridemia. Both developed iatrogenic physiologic opioid dependence after frequent hospitalizations and opioid prescriptions. Both patients stabilized after initiation of buprenorphine, remaining in care and hospitalization-free for over a year. These cases illustrate the importance of identifying and treating the underlying etiology of abdominal pain, judiciously prescribing opioids to treat pancreatitis flares, and having a low threshold for considering iatrogenic physiologic opioid dependence in patients evaluated for recurrent pancreatitis. They also highlight the potential role that buprenorphine can play to mitigate recurrent admissions by providing safer pain control and treatment for physiologic opioid dependence.