Association for Academic SurgeryImpact of preexisting opioid use on injury mechanism, type, and outcome
Introduction
The increasing prevalence of prescription opioid analgesics in the United States over the past decade has been well documented. Opioid prescriptions per 100 persons in the United States increased by 35.2% during the period 2000–2009 [1]. It is estimated that in 2011, opioid analgesics were prescribed over 238 million times [2]. Escalation of the use of illicit opioids has also contributed to the overall prevalence of narcotics with an estimated 5.1 million Americans aged ≥12 y having used narcotic pain relievers in the past month [2]. Determining the true prevalence of opioid use is challenging. According to the National Center for Health Statistics, 4.2% of US adults reported the use of opioid analgesics for pain within the prior month from 1999–2002 [2], [3]. Another report estimated that 4.9% of adults used opioids regularly, based on random phone interviews from 1998–2006 [4].
Although prescription narcotics are an important component of the management of acute and chronic pain, the adverse effects of such drugs have become an area of increased concern. Numerous studies have reported an association between opioid prescribing and poorer health status including increased disability, medical costs, and subsequent surgery [2], [5], [6]. The impact that these medications have on the trauma population is uncertain. Increased pain tolerance, withdrawal, and poorer outcomes are all potential ramifications of increasing opioid use in the public. There have been many previous studies documenting the use of narcotics and pain control for injured patients after trauma but few have addressed the influence that preinjury narcotic use has on trauma outcomes.
With such an overall increase in the use of prescription narcotics, hospitals and trauma centers are faced with the challenge of managing acute pain in patients who have already developed some degree of tolerance to opioids before presentation. Consequently, it would be reasonable to conclude that the management of such patients would be more complex resulting in potentially worse outcomes. The purpose of this study was to determine the prevalence of preinjury narcotic use in the trauma population at a level 1 trauma center and define the characteristics of these patients. We hypothesize that preinjury narcotic use impacts hospital length of stay and seeks to characterize this potential effect. Finally, we seek to determine whether patients who take narcotics before their injury have different injury characteristics and clinical course as a result of their preexisting use of pain medication as compared with the remainder of the trauma population.
Section snippets
Methods
Approval for this study was obtained from the Institutional Review Board at Grant Medical Center, an adult level 1 trauma center in Columbus, OH, with approximately 4000 trauma admissions annually. This retrospective review included 4352 consecutive patients obtained from the trauma registry database over a 12-month period from January 1, 2010–December 31, 2010. A total of 239 patients who were not seen or evaluated by the trauma surgery service were excluded leaving 4113 patients for initial
Results
Data from 4352 patients were gathered from the trauma database. Patients not seen by the trauma service, dying within 24 h of presentation, and those with absent or incomplete data were excluded leaving 3953 patients for analysis. Table 1 shows baseline characteristics of the patient population. Mean age was 42.3 y (range 16–102). There were 2696 males (68.2%) versus 1257 females (31.8%). Patients presented as category 1 trauma alert (12.7%), category 2 trauma alert (70.0%), or consultations
Discussion
Much has been written in the past few years about the increasing epidemic of opioid use and abuse in the United States. Though narcotic pain medications are often prescribed in an effort to better treat acute and chronic pain, the dramatic and continued increase deserves attention. Climbing numbers of prescriptions as well as the rise in illicit use has resulted in increased consumption of narcotics in the United States. Sales of opioid analgesics quadrupled from 1999–2010 [2]. With this
Acknowledgment
The authors acknowledge the assistance of Ed Buggie in organization and statistical analysis of the data.
Authors' contributions: U.P., M.S.O., and J.O designed this study. U.P, J.O, and W.W. performed the literature search. U.P., M.L., and W.W performed the data collection. U.P., M.S.O., M.L., W.W., and J.O. interpreted the data. U.P. wrote the article. U.P., M.S.O., W.W., M.L., and J.O. contributed to the critical revision of the article.
References (16)
- et al.
Prevalence and characteristics of opioid use in the US adult population
Pain
(2008) - et al.
Trends in prescriptions for oxycodone and other commonly used opioids in the United States, 2000-2010
Open Med
(2012) - et al.
Opioid epidemic in the United States
Pain Physician
(2012) Health, United States, 2008 with chartbook
(2009)- et al.
Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective
Pain Physician
(2010) - et al.
Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids
Pain Physician
(2008) - et al.
A population-based cohort study on chronic pain: the role of opioids
Clin J Pain
(2010) - Letter to Janet Woodcock, MD, Director, Center for Drug Evaluation and Research, U.S. Food and Drug Administration,...
Cited by (24)
Standardizing Opioids Prescribed at Discharge in Trauma Surgery
2023, Journal of Surgical ResearchA serial cross-sectional study of trends and predictors of prescription controlled substance-related traumatic injury
2022, Preventive MedicineCitation Excerpt :Studies that examined patient and injury characteristics associated with controlled substance-related trauma report varying findings, likely as a result of differing definitions of substance use. Previous research found the injury mechanisms of fall were more likely and firearm less likely to be associated with controlled substances, while another study found no differences in injury mechanisms for those who tested positive for controlled substances (Pandya et al., 2015; Cannon et al., 2014; Soderstrom et al., 2001). Results from the present study specifically examining PCS found a wide range of injury mechanisms associated with PCS demonstrating the broad risk of injury associated with PCS use.
Opioids and Injury Deaths: A population-based analysis of the United States from 2006 to 2017
2021, InjuryCitation Excerpt :The relationship between opioid use and incidence of traumatic injury has been explored previously. In injured patients, opioid dependency and prior use are associated with inferior clinical outcomes, including increased in-hospital mortality and repeated traumatic injury [11–15]. One particular study showed that orthopaedic trauma patients had a higher rate of prescription opioid use pre-injury compared to a control population [16].
The rise of non-traumatic extremity compartment syndrome in light of the opioid epidemic
2021, American Journal of Emergency MedicineOpioid dependency is independently associated with inferior clinical outcomes after trauma
2019, InjuryCitation Excerpt :This study demonstrates that 18% of patients were dependent on opioids prior to their trauma admission. This corroborates the results from recent studies of trauma populations which report the prevalence of opioid use from 16% to 20% [13,14]. In comparison, the prevalence of opioid use among the adult population in the United States is estimated to be approximately 5% [15].
The Impact of Pain Management with Opioids among Older Adults Post Orthopedic Trauma
2016, Pain Management NursingCitation Excerpt :Following assessment, there are numerous ways in which pain is managed post orthopedic trauma, with the most common being use of opioids via a variety of delivery modalities: orally, intravenously through patient-controlled mechanisms, intercostal nerve blocks with the use of an intrapleural catheter, with epidural analgesia, and via sympathetic blocks (Abou-Setta et al., 2011). Although there is a need to manage pain after a traumatic fracture, there are significant concerns that opioid use increases the risk of adverse events, particularly delirium and falls among older adults (Chang et al., 2011; Greer et al., 2011; Jain et al., 2011; Mattison et al., 2014; Pandya, Omara, Wilson, Opalek, & Lieber, 2015; Pisani, Murphy, Araujo, & Van Ness, 2010). Given the requirement to evaluate and manage pain, the impact of pain on recovery following an orthopedic trauma and the consequences of treatment versus no treatment of pain, requires additional research to consider current pain management practices among older orthopedic trauma patients and the effect that treatment has on outcomes.