OBJECTIVE Opioid use in Asian patients with inflammatory bowel disease (IBD) remains poorly understood. This study aimed to investigate the trends in chronic opioid use, associated clinical factors, and effects of advanced therapy (AT) on opioid use in Korean patients with IBD.

METHODS This nationwide cohort study used administrative claims data from the Korean National Health Insurance Service (2010-2022). Chronic opioid use was defined as opioid use for ≥90 days or ≥3 prescriptions within a calendar year. Logistic regression was used to identify clinical factors associated with chronic opioid use. The impact of AT on opioid use was analyzed through pre- and post-initiation comparisons using McNemar's tests, generalized estimating equations (GEE), and a linear mixed model.

RESULTS Chronic opioid use increased over the study period, with a higher prevalence in Crohn's disease (CD) than in ulcerative colitis (UC) (CD: 1.38%, UC: 0.53% in 2010; CD: 5.38%, UC: 1.98% in 2020). Among 49 548 newly diagnosed IBD patients, female sex, steroid and immunomodulator treatments, hospitalizations, emergency room visits, and mental disorders were positively associated with chronic opioid use in CD and UC. AT was positively associated with chronic opioid use in UC (odds ratio [OR] 1.627, P < .0001) but negatively associated with CD (OR 0.786, P = .0013). In CD, AT significantly reduced opioid users (McNemar's test: P < .0001; GEE: OR 0.478, P < .0001) and average daily doses (mean difference -15.8 morphine milligram equivalents, P = .0073).

CONCLUSION Chronic opioid use has increased over the past decade among Korean patients with IBD, particularly among those with CD. AT is crucial for reducing opioid use in patients with CD.