Predictors of Long-Term Opioid Use Following Hospitalization for Traumatic Injury in a Racially and Ethnically Diverse Population

Background

Long-term prescription opioid use is a significant risk factor for opioid morbidity and mortality and severe traumatic injury is an important initiation point for prescription opioid use. This study examines predictors of long-term prescription opioid use among a racially and ethnically diverse population of patients hospitalized for traumatic injury.

Methods

650 study participants from two urban Level I trauma centers were enrolled. Baseline information on demographics, injury characteristics, self-reported pre-injury substance use and mental health, and personality characteristics and attitudes were collected through interviews during the initial hospitalization. Patients were interviewed again at 3-months and 12-months and asked about prescription opioid use in the past 7 days. Multivariable logistic regressions assessed participants' baseline characteristics associated with opioid use at one or more follow-up interview.

Results

Pre-injury use of prescription painkillers had the strongest association with prescription opioid use at follow-up (Adjusted Odds Ratio: 3.10, 95% Confidence Interval: 1.86, 5.17). Older age, health insurance coverage at baseline, length of hospitalization, higher current pain, pre-injury post-traumatic stress disorder symptoms, and discharge to a location other than home were also associated with significantly higher odds of prescription opioid use at follow-up.

Conclusions

Providers may consider screening for past use of prescription pain relievers and post-traumatic stress disorder prior to hospital discharge and to identify patients who may benefit from additional resources and support. However, providers should ensure that these patients' pain management needs are still being met and avoid abrupt discontinuation of prescription opioid use among those with history of long-term use.