Association of Lifetime History of Traumatic Brain Injury With Prescription Opioid Use and Misuse Among Adults

Adams, Rachel Sayko; Corrigan, John; Ritter, Grant; Hagemeyer, Abby N; Pliskin, Madeline B; Reif, Sharon

doi:10.1097/htr.0000000000000729

Cited by 11 publications

(12 citation statements)

References 48 publications

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“…Adams and colleagues 36 examined the association of lifetime history of TBI with past year prescription opioid use and misuse among adults using data from the 2018 Ohio Behavioral Risk Factor Surveillance System survey. They found that adults with a lifetime history of TBI had 1.5 times the odds of past year prescription opioid use and 1.7 times the odds of past year prescription opioid misuse, compared with adults without TBI, controlling for sex, age, race/ethnicity, and marital status.…”

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confidence: 99%

Traumatic Brain Injury and Opioid Use: Additional Evidence Supporting the “Perfect Storm” of Cascading Vulnerabilities

Adams

2021

Journal of Head Trauma Rehabilitation

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Human Services declared the opioid epidemic a public health emergency in 2017, 1 prescription opioid rates had been declining for several years. 2 Yet, alarmingly, despite broad, multifaceted policy changes and interventions launched to curb the epidemic, opioidrelated overdose deaths have increased by almost 5% from 2018 to 2019. 3,4 Mortality associated with the opioid epidemic has been characterized by 3 waves, 5 with the first wave fueled by increasing prescription opioid medications beginning in the 1990s, the second wave characterized by overdose deaths involving heroin starting around 2010, and the third wave driven by overdose deaths involving synthetic opioids (eg, fentanyl) starting in 2013. 5 In recent years, traumatic brain injury (TBI) researchers, rehabilitation providers, funders, family members, and persons living with TBI have directed attention to understanding how the opioid epidemic has affected persons with TBI in the United States. 6 There was speculation that persons with TBI may be at a greater risk for receiving prescription opioids due to secondary conditions common after injury (eg, pain) 6,7 ;The author thanks Kristen Dams-O'Connor, PhD, for her thoughtful review and contributions to this Foreword.

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confidence: 99%

Traumatic Brain Injury and Opioid Use: Additional Evidence Supporting the “Perfect Storm” of Cascading Vulnerabilities

Adams

2021

Journal of Head Trauma Rehabilitation

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“…Opiate history was collected using questions from the Ohio Behavioral Risk Factor Surveillance System survey 12. Participants who endorsed “Yes” to either of the following 2 questions were included in the opiate misuse category (ie, “Opiate Misuse-Yes” or “O Y ”): (1) “The last time you filled a prescription for opioid pain medication, did you use any of the pain medication more frequently or in higher doses than directed by a healthcare provider?” or (2) “In the past year, did you use prescription opioid pain medication that was NOT prescribed to you?” This variable elicited misuse of prescription opiate medication and did not include illicit opiate use.…”

Section: Methodsmentioning

confidence: 99%

“…Although alcohol use after TBI is well-documented,6–8 there is less information regarding opiate and marijuana use despite clinically observed high rates for each. Nevertheless, previous studies have consistently indicated that individuals with TBI exhibit significantly elevated rates of opiate misuse and overdose compared with those without TBI 9–12. Notably, traits such as being male and having a history of substance use disorder are associated with occurrence of both TBI and opiate misuse 13.…”

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confidence: 99%

The Interaction of Opiate Misuse and Marijuana Use on Behavioral Health Outcomes Using the Traumatic Brain Injury Model Systems Pain Collaborative Dataset

Callender,

Lai,

Driver

et al. 2024

Journal of Head Trauma Rehabilitation

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Objective: To determine if the interaction of opiate misuse and marijuana use frequency is associated with behavioral health outcomes. Setting: Community. Participants: Three thousand seven hundred fifty participants enrolled in the Traumatic Brain Injury Model Systems who completed the Pain Survey and had complete opioid use and marijuana use information. Design: Cross-sectional, secondary analysis from a multisite observational cohort. Main Outcome Measure(s): Clinically significant behavioral health symptoms for posttraumatic stress disorder (PTSD), depression, anxiety, and sleep quality. Results: Three thousand five hundred thirty-five (94.3%) participants did not misuse opiates, 215 (5.7%) did misuse opiates (taking more opioid pain medication than prescribed and/or using nonprescription opioid pain medication); 2683 (70.5%) participants did not use marijuana, 353 (9.3%) occasionally used marijuana (less than once a week), and 714 (18.8%) regularly used marijuana (once a week or more frequently). There was a statistically significant relationship (P < .05) between the interaction of opiate misuse and marijuana use frequency and all behavioral health outcomes and several covariates (age, sex, cause of injury, severity of injury, and pain group category). Pairwise comparisons confirm that statistically significant associations on behavioral health outcomes are driven by endorsing opiate misuse and/or regular marijuana use, but occasional marijuana use was not associated. Conclusions: Higher odds of clinically significant PTSD, depression, anxiety, and poor sleep quality are present in people with traumatic brain injury (TBI) who misuse opiates and/or who use marijuana regularly. In the absence of opiate misuse, regular marijuana use had higher odds of worse behavioral health outcomes than occasional and no use. The interaction of opiate misuse and regular marijuana use yielded the highest odds. Individuals with TBI should be informed of the relationship of substance use and behavioral health outcomes and that current chronic pain may mediate the association.

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“…17 People with a history of traumatic brain injury (TBI), who are more likely to receive opioids than those without TBI, have greater risk for opioid misuse and overdose. 19 Despite these reports, research examining OUD treatment is lacking for PWD.…”

Section: Introductionmentioning

confidence: 99%

“…Certain PWD subgroups have higher risk of opioid misuse and opioid-related consequences, although findings are not consistent . People with a history of traumatic brain injury (TBI), who are more likely to receive opioids than those without TBI, have greater risk for opioid misuse and overdose . Despite these reports, research examining OUD treatment is lacking for PWD.…”

Section: Introductionmentioning

confidence: 99%

Quality of Opioid Use Disorder Treatment for Persons With and Without Disabling Conditions

et al. 2023

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ImportanceAdverse outcomes associated with opioid use disorder (OUD) are disproportionately high among people with disabilities (PWD) compared with those without disability. A gap remains in understanding the quality of OUD treatment for people with physical, sensory, cognitive, and developmental disabilities, specifically regarding medications for OUD (MOUD), a foundation of treatment.ObjectiveTo examine the use and quality of OUD treatment in adults with diagnosed disabling conditions, compared with adults without these diagnoses.Design, Setting, and ParticipantsThis case-control study used Washington State Medicaid data from 2016 to 2019 (for use) and 2017 to 2018 (for continuity). Data were obtained for outpatient, residential, and inpatient settings with Medicaid claims. Participants included Washington State full-benefit Medicaid enrollees aged 18 to 64 years, continuously eligible for 12 months, with OUD during the study years and not enrolled in Medicare. Data analysis was performed from January to September 2022.ExposuresDisability status, including physical (spinal cord injury or mobility impairment), sensory (visual or hearing impairments), developmental (intellectual or developmental disability or autism), and cognitive (traumatic brain injury) disabilities.Main Outcomes and MeasuresThe main outcomes were National Quality Forum–endorsed quality measures: (1) use of MOUD (buprenorphine, methadone, or naltrexone) during each study year and (2) 6-month continuity of treatment (for those taking MOUD).ResultsA total of 84 728 Washington Medicaid enrollees had claims evidence of OUD, representing 159 591 person-years (84 762 person-years [53.1%] for female participants, 116 145 person-years [72.8%] for non-Hispanic White participants, and 100 970 person-years [63.3%] for participants aged 18-39 years); 15.5% of the population (24 743 person-years) had evidence of a physical, sensory, developmental, or cognitive disability. PWD were 40% less likely than those without a disability to receive any MOUD (adjusted odds ratio [AOR], 0.60; 95% CI, 0.58-0.61; P &lt; .001). This was true for each disability type, with variations. Individuals with a developmental disability were least likely to use MOUD (AOR, 0.50; 95% CI, 0.46-0.55; P &lt; .001). Of those using MOUD, PWD were 13% less likely than people without disability to continue MOUD for 6 months (adjusted OR, 0.87; 95% CI, 0.82-0.93; P &lt; .001).Conclusions and RelevanceIn this case-control study of a Medicaid population, treatment differences were found between PWD and people without these disabilities; these differences cannot be explained clinically and highlight inequities in treatment. Policies and interventions to increase MOUD access are critical to reducing morbidity and mortality among PWD. Potential solutions include improved enforcement of the Americans with Disabilities Act, workforce best practice training, and addressing stigma, accessibility, and the need for accommodations to improve OUD treatment for PWD.

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Association of Lifetime History of Traumatic Brain Injury With Prescription Opioid Use and Misuse Among Adults

Cited by 11 publications

References 48 publications

Traumatic Brain Injury and Opioid Use: Additional Evidence Supporting the “Perfect Storm” of Cascading Vulnerabilities

Traumatic Brain Injury and Opioid Use: Additional Evidence Supporting the “Perfect Storm” of Cascading Vulnerabilities

The Interaction of Opiate Misuse and Marijuana Use on Behavioral Health Outcomes Using the Traumatic Brain Injury Model Systems Pain Collaborative Dataset

Quality of Opioid Use Disorder Treatment for Persons With and Without Disabling Conditions

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