Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study
Author:
Punches Brittany E.ORCID, Stolz Uwe, Freiermuth Caroline E., Ancona Rachel M., McLean Samuel A., House Stacey L., Beaudoin Francesca L., An Xinming, Stevens Jennifer S., Zeng Donglin, Neylan Thomas C., Clifford Gari D., Jovanovic Tanja, Linnstaedt Sarah D., Germine Laura T., Bollen Kenneth A., Rauch Scott L., Haran John P., Storrow Alan B., Lewandowski ChristopherORCID, Musey Paul I., Hendry Phyllis L., Sheikh SophiaORCID, Jones Christopher W., Kurz Michael C., Gentile Nina T., McGrath Meghan E., Hudak Lauren A., Pascual Jose L., Seamon Mark J., Harris Erica, Chang Anna M., Pearson Claire, Peak David A., Merchant Roland C., Domeier Robert M., Rathlev Niels K., O’Neil Brian J., Sanchez Leon D., Bruce Steven E., Pietrzak Robert H., Joormann Jutta, Barch Deanna M., Pizzagalli Diego A., Smoller Jordan W., Luna Beatriz, Harte Steven E., Elliott James M.ORCID, Kessler Ronald C., Ressler Kerry J., Koenen Karestan C., Lyons Michael S.
Abstract
Objective
Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use.
Methods
Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months.
Results
Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5).
Conclusions
ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.
Funder
National Institute on Drug Abuse National Institute of Mental Health US Army Medical Research and Material Command The One Mind Foundation The Mayday Fund
Publisher
Public Library of Science (PLoS)
Subject
Multidisciplinary
Cited by
2 articles.
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