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Narcotic use in patients following a traumatic injury

Audis Bethea, PharmD, BCPS, BCCCP, Damayanti Samanta, MS, Kellie Amodeo, MD

Abstract


Objective: To determine the incidence and factors associated with long-term opioid use in trauma patients who were previously opioid-naïve.

Design: A retrospective cohort study.

Setting: Level I Trauma Center.

Patients, participants: Patients admitted to the study institution between January and October 2016 following traumatic injury. Trauma patients were linked with data from the state's Controlled Substance Monitoring Program (CSMP) database regarding controlled substance use.

Main outcome measure(s): Long-term use (LTU) of opioid medications following hospital discharge. Long-term use was defined as 4 weeks and above based on the Centers for Disease Control and Prevention's recommendation that opioid therapy should not be continued for > 4 weeks without a clinician evaluating the risk versus benefits of continued therapy.

Results: The incidence of LTU in previously naïve patients was 46 percent. Preexisting psychiatric illness (OR = 4.764, 95 percent CI = 1.592-14.260, p = 0.005) and prior controlled substance use (OR = 4.155, 95 percent CI = 1.903-9.072) were determined to be predictors for LTU. Patients with psychiatric comorbid conditions were almost five times more likely to be in the LTU group. Those with prior controlled substance use history were four times more likely to be in the LTU group.

Conclusions: These findings provide initial insight concerning the LTU of opioids in previously naïve patients. Application of these data may facilitate early identification of patients at risk for LTU following traumatic injury and serve to influence prescribing practices in these at-risk individuals.


Keywords


trauma, in-hospital narcotic exposure, opioid-naïve, long-term opioid use

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References


Kotecha MK, Sites BD: Pain policy and abuse of prescription opioids in the USA: A cautionary tale for Europe. Anaesthesia. 2013; 68(12): 1210-1215.

Center for Disease Control and Prevention: CDC guidelines for prescribing opioids for chronic pain—Unites States. 2016. Accessed July 1, 2016.

Reisman RM, Shenoy PJ, Atherly AJ, et al.: Prescription opioid usage and abuse relationships: An evaluation of state prescription drug monitoring program efficacy. Subst Abuse. 2009; 3: 41-51.

Center for Disease Control and Prevention: Drug overdose deaths. Available at https://www.cdc.gov/drugoverdose/data/statedeaths.html. Accessed October 1, 2019.

Hall AJ, Logan JE, Toblin RL, et al.: Patterns of abuse among unintentional pharmaceutical overdose fatalaties. JAMA. 2008; 300: 2613-2621.

Crombie IK, Davies HTO, Macrae WA: Cut and thrust: Antecedent surgery and trauma among patients attending a chronic pain clinic. Pain. 1998; 76(1-2): 167-171.

Attenberger C, Amsler F, Gross T: Clinical evaluation of the Trauma Outcome Profile (TOP) in the longer-term follow-up of polytrauma patients. Injury. 2012; 43(9).

Gross T, Amsler F: Prevalence and incidence of longer term pain in survivors of polytrauma. Surgery. 2011; 150(5): 985-995.

McCarthy DM, Wolf MS, McConnell R, et al.: Improving patient knowledge and safe use of opioids: A randomized controlled trial. Acad Emerg Med. 2015; 22(3): 331-339.

Prescription Drug Monitoring Program: Prescription drug monitoring frequently asked questions (FAQ). Available at http://www.pdmpassist.org/content/prescription-drug-monitoring-frequentlyasked-questions-faq. Accessed July 22, 2016.

West Virginia Board of Pharmacy: CS monitoring program. Available at http://www.wvbop.com/index.php?option=com_content&view=article&id=99&Itemid=117. Accessed July 22, 2016.

West Virginia Board of Pharmacy: Available at https://www.wvbop.com/article.asp?id=23. Accessed October 20, 2019.

Chaudhary MA, Schoenfeld AJ, Harlow AF, et al.: Incidence and predictors of opioid prescription at discharge after traumatic injury. JAMA Surg. 2017; 152(10): 930-936.

Alghnam S, Castillo R: Traumatic injuries and persistent opioid use in the USA: Findings from a nationally representative survey. Inj Prev. 2017; 23(2): 87-92.

Zwisler ST, Hallas J, Larsen MS, et al.: Opioid prescriptions before and after high-energy trauma. J Opioid Manag. 2015; 11(4): 313-318.

Holman JE1, Stoddard GJ, Higgins TF: Rates of prescription opiate use before and after injury in patients with orthopaedic trauma and the risk factors for prolonged opiate use. J Bone Joint Surg Am. 2013; 95(12): 1075-1080.

Morris BJ, Zumsteg JW, Archer KR, et al.: Narcotic use and postoperative doctor shopping in the orthopaedic trauma population. J Bone Joint Surg Am. 2014; 96(15): 1257-1262.

Klimas J, Gorfinkel L, Fairbairn N, et al.: Strategies to identify patient risks of prescription opioid addiction when initiating opioids for pain: A systematic review. JAMA Netw Open. 2019; 2(5): e193365.

Boscarino JA, Rukstalis M, Hoffman SN, et al.: Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction. 2010; 105(10): 1776-1782.

Massey GM1, Dodds HN, Roberts CS, et al.: Toxicology screening in orthopedic trauma patients predicting duration of prescription opioid use. J Addict Dis. 2005; 24(4): 31-41.

McDonald DC, Carlson KE: Estimating the prevalence of opioid diversion by “doctor shoppers” in the United States. PLoS One. 2013; 8(7): e69241. doi:10.1371/journal.pone.0069241

Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Available at https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf. Accessed January 8, 2020.

Paulozzi LJ, Budnitz DS, Xi Y: Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf. 2006; 15: 618-627.

Jones CM: Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers—United States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013; 132(1-2): 95-100.




DOI: https://doi.org/10.5055/jom.2020.0601

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