Background: With the dramatic increase in the usage of opioids for not only inpatient but also outpatient pain management, a potential increase in opioid-related deaths had led to a national concern regarding opioid usage. The World Health Organization analgesic ladder estimates 90% of the global population will use opioids at least once in their life, and with the high prevalence, more complications started to be reported in the literature. The incidence of several gastrointestinal disorders such as chronic diverticular has been proposed and associated with opioid-related mortality, thus we aim in our systematic review and meta-analysis to further analyze the risk and potential harms of opioid-induced colonic diverticular disease (CDD).

Methods: we systematically searched electronic databases, including PubMed CENTRAL, Scopus, Cochrane, EMBASE, and Google scholar databases. Eligibility criteria include both observational and interventional studies with no language restriction, yet we exclude letters to editors, conference abstracts, reviews, and animals studies. We searched studies for risk of development CDD, hospitalization, and mortality. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated using random-effects models.

Results: Eight studies were included with a total of 10476 patients: 1073 patients in the opioids group and 9403 in the placebo group. Compared to placebo, a significant risk was observed in the opioid group for developing CDD with RR 2.03 (95% CI [1.77 to 2.32], p-value < 0.001). In comparison to the placebo group, opioid-induced CDD patients were at more risk to die with an RR of 1.2 (95% CI [0.86 to 1.54], p-value < 0.01), yet with no significant difference regarding the risk of hospitalization.

Conclusions: Although opioid is considered the mainstay treatment for any post-operative pain, opioid-associated adverse events and mortality have been strikingly increasing in the past decade. Moreover, Opioid-induced CDD has increased with an increased risk of mortality. Thus, we call physicians to have a high index when prescribing opioids and try to manage their associated adverse effects.