Persistent Long-Term Opioid Use After Trauma: Incidence and Risk Factors

Abstract

Background The opioid epidemic in the United States continues to lead to a substantial number of preventable deaths and disability. The development of opioid dependence has been strongly linked to previous opioid exposure. Trauma patients are at particular risk since opioids are frequently required to control pain after injury. The purpose to this study was to examine the prevalence of opioid use before and after injury and to identify risk factors for persistent long-term opioid use after trauma. Methods Records for all patients admitted to a Level 1 trauma center over a one-year period were analyzed. Demographics, injury characteristics, and hospital course were recorded. A multi-state Prescription Controlled Drug Monitoring Program (PDMP) database was queried to obtain records of all controlled substances prescribed from 6 months prior to the date of injury to 12 months after hospital discharge. Patients still receiving narcotics at 1 year were defined as persistent long-term users and were compared against those who were not. Results 2992 patients were analyzed. 20.4% of patients had filled a narcotic prescription within the 6 months prior to injury. 53.5% of patients received opioids at hospital discharge. 12.5% of patients had persistent long-term use after trauma with the majority demonstrating pre-injury use. Univariate risk factors for long term use included female sex, longer length of stay, higher injury severity score, anxiety, depression, orthopedic surgeries, spine injuries, multiple surgical locations, discharge to acute inpatient rehab, and pre-injury opioid use. On multi-variate analysis, the only significant predictors of persistent long-term prescription opioid use were pre-injury use, as well as a much smaller effect associated with use at discharge. Conclusion During a sustained opioid epidemic, concerns and caution are warranted in the use of prescription narcotics for trauma patients. However, persistent long-term opioid use among opioid naïve patients is rare and difficult to predict after trauma. Level of Evidence III, Prognostic/Epidemiological