Risk factors and outcomes of chronic opioid use following trauma

Abstract

Background The growing problem of opioid misuse has become a serious crisis in many countries. The role of trauma as a gateway to opioid use is currently not determined. The study was undertaken to assess whether traumatic injury might be associated with chronic opioid use and accompanying increased long‐term mortality. Methods Injured patients and controls from Sweden were matched for age, sex and municipality. After linkage to Swedish health registers, opioid consumption was assessed before and after trauma. Among injured patients, logistic regression was used to investigate factors associated with chronic opioid use, assessed by at least one written and dispensed prescription in the second quarter after trauma. Cox regression was employed to study excess risk of mortality. In addition, causes of death for postinjury opioid users were explored. Results Some 13 309 injured patients and 70 621 controls were analysed. Exposure to trauma was independently associated with chronic opioid use (odds ratio 3·28, 95 per cent c.i. 3·02 to 3·55); this use was associated with age, low level of education, somatic co‐morbidity, psychiatric co‐morbidity, pretrauma opioid use and severe injury. The adjusted hazard ratio for death from any cause 6–18 months after trauma for chronic opioid users was 1·82 (95 per cent c.i. 1·34 to 2·48). Findings were similar in a subset of injured patients with no pretrauma opioid exposure. Conclusion Traumatic injury was associated with chronic opioid use. These patients have an excess risk of death in the 6–18 months after trauma.

Impact of opioid use disorder on resource utilization and readmissions after operative trauma

“…33À37 Although OUD trauma patients appear to have lower long-term survival related to substance abuse, the underlying mechanisms of lower in-hospital mortality warrant further investigation. 38,39 Nevertheless, OUD appears to result in significant morbidity and negatively impact resource use. A prior study by Cannon et al demonstrated OUD trauma patients have longer intensive care duration of stay and need for mechanical ventilation.…”

Smerter og smertebehandling de første to ukene etter store skader

“…Vi vet ikke hva slags muntlig informasjon pasientene fikk, men dette er i lys av den aktuelle diskusjonen om opioidmisbruk et viktig forbedringspunkt. Det er vist i et svensk materiale at risikoen for opioidmisbruk var mer enn tre ganger så stor hos dem som hadde vaert utsatt for skade enn hos kontrollpopulasjonen (5). Spesielt langvarig bruk etter utskrivning etter en skade eller operasjon er assosiert med økt fare for misbruk (6).…”

Do Lidocaine Patches Reduce Opioid Use in Acute Rib Fractures?

“…While some researchers have found that opioids prescribed after acute traumatic injury do not lead to long-term use, others have found that a significant number of patients prescribed chronic opioids misuse opioid analgesics, and there is an independent association with increased risk of death in the 6-18 months following trauma in those patients with chronic opioid use. 23,26,27 Thus, pain management algorithms that adequately treat severe pain while simultaneously lowering opioid use should be pursued. 28 We also evaluated clinically significant secondary endpoints, including pulmonary complications and length of hospital stay.…”