Annual trends of chronic opioid use in patients with inflammatory bowel disease and spondyloarthritis in Denmark between 2000 and 2023

OBJECTIVE: Patients with inflammatory bowel disease (IBD) and concomitant spondyloarthritis (SpA) experience substantial pain burden. We examined long-term trends in chronic opioid use (COU) among patients with IBD with and without SpA in Denmark. METHOD: Using nationwide Danish health registers, we identified patients with Crohn's disease or ulcerative colitis between 2000 and 2023. SpA was defined using validated International Classification of Diseases, 10th Revision (ICD-10) codes. COU was defined as the dispensing of three or more opioid prescriptions within a 12 month period, with prescriptions separated by at least 30 days. Annual proportions of COU were calculated for patients with IBD with SpA (IBD + SpA) and IBD without SpA. A subgroup analysis evaluated chronic use of strong opioids exclusively. Temporal trends were assessed descriptively and comparisons between groups were performed using logistic regression with robust variance. RESULTS: The IBD population increased from 13 417 patients in 2000 to 51 230 in 2023, while the proportion with SpA increased from 1.6% to 5.5%. COU declined over time in both groups. Among patients without SpA, COU decreased from 9.8% in 2000 to 5.7% in 2023. In contrast, COU remained substantially higher in IBD + SpA patients, declining from 27.0% to 13.7% over the same period (p < 0.001). Chronic strong opioid use remained stable in patients without SpA but increased in IBD + SpA patients from 3.6% to 6.2% (p < 0.001). CONCLUSION: Despite overall reductions in opioid prescribing, COU, particularly strong opioid use, remains disproportionately high among patients with IBD + SpA. These findings suggest persistent unmet needs in pain management for this high-risk population.