Persistent post-discharge opioid prescribing after traumatic brain injury requiring intensive care unit admission: A cross-sectional study with longitudinal outcome

Abstract

Traumatic brain injury (TBI) is associated with increased risk for psychological and substance use disorders. The study aim is to determine incidence and risk factors for persistent opioid prescription after hospitalization for TBI. Electronic medical records of patients age ≥ 18 admitted to a neuroscience intensive care unit between January 2013 and February 2017 for an intracranial injury were retrospectively reviewed. Primary outcome was opioid use through 12 months post-hospital discharge. A total of 298 patients with complete data were included in the analysis. The prevalence of opioid use among preadmission opioid users was 48 (87%), 36 (69%) and 22 (56%) at 1, 6 and 12-months post-discharge, respectively. In the opioid naïve group, 69 (41%), 24 (23%) and 17 (19%) were prescribed opioids at 1, 6 and 12 months, respectively. Preadmission opioid use (OR 324.8, 95% CI 23.1–16907.5, p = 0.0004) and higher opioid requirements during hospitalization (OR 4.5, 95% CI 1.8–16.3, p = 0.006) were independently associated with an increased risk of being prescribed opioids 12 months post-discharge. These factors may be used to identify and target at-risk patients for intervention.

Insights into Critical Care and Post-ICU Opiate Administration

“…The authors conclude an “analgesia-first” approach to ICU sedation does not result in high rates of subsequent long-term opioid use. Their findings echo preliminary results from a U.S. medical unit reporting 7% ICU survivors with opiate prescriptions at hospital discharge ( 4 ) and contrast with ICU survivors with traumatic brain injuries, in whom opiate prescriptions were 41% at 1 month and 21% at 12 months after ICU ( 5 ).…”

The complications of opioid use during and post–intensive care admission: A narrative review

“…Dunn et al. 70 also found a high incidence of opioid prescription, with 61% and 44% of traumatic brain-injured patients still receiving an opioid prescription at six and 12 months, respectively. Wampole et al.…”

“…The incidence of chronic post-ICU opioid use ranges from 2.6% to 16.3% in patients who were opioid-naive prior to ICU admission. 1,34,70 –72,74 –79 Trials with a larger incidence of persistent opioid use used a definition of single prescriptions of opioids. Using a time-based prescription of 120 days of opioid supply within the first year after ICU hospitalisation, Wunsch et al.…”

“…These data suggest that there is a decrease in opioid use over time after ICU discharge for both patients who are opioid naive and those receiving chronic opioid therapy. 70,74,80 This reduction may be a result of improved follow-up services, in which chronic opioid therapy may be weaned or discontinued. However, follow-up studies are notorious for loss to follow-up.…”

“…The few studies that have investigated this all used a definition of a single prescription, rather than a time-based definition of chronic opioid therapy. 34,70,78 As there is no consensus definition of chronic opioid therapy, it is a difficult endpoint to study. In addition, the exposure of opioid dose was a cumulative dose for the entire ICU admission, which ignores the varying nature of opioid exposure and confounders.…”