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Abstract
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This project was concerned with examining substance use both before and following involvement in road crashes causing serious injury. It was comprised of two data analysis studies, one on fatal crashes and one on hospital admission cases, a literature review on substance use by those with injury types included within the Lifetime Support Scheme (LSS), and a discussion of potential studies to look at post-injury substance use among seriously injured road users in South Australia. Substance use was found to be involved in a large proportion of hospital admission and fatal injury crashes. A direct contribution to fatal crashes of substance use was found in 36% of cases. An illegal BAC and illicit drug use were found in similar proportions of cases, while combinations of multiple substance types were common. The literature review revealed that post-injury substance use often replicated pre-injury substance use and often results in worse outcomes. Management of pain is a critical issue post-injury for the injury types within the LSS. Opioids are frequently prescribed to treat chronic pain but alternative therapies need to be explored to avoid some of the negative effects of long term opioid use.
This project was concerned with examining substance use both before and following involvement in road crashes causing serious injury. It was comprised of two data analysis studies, one on fatal crashes and one on hospital admission cases, a literature review on substance use by those with injury types included within the Lifetime Support Scheme (LSS), and a discussion of potential studies to look at post- injury substance use among seriously injured road users in South Australia.
The choice of an analysis of fatal crashes and crashes resulting in hospital admission was made on the basis that LSS participants are likely to represent an ‘average’ between these two groups. In any case, the findings of the fatal and hospital admission-based analyses revealed a number of similarities between these groups in terms of pre-crash substance use, that are therefore likely to be generalisable to LSS participants. These similar findings include:
• Around half of both fatal and hospital admission cases were positive to at least one substance
• Illicit drugs and an illegal BAC appeared in similar proportions, with combinations of different substance types being common
• Substance use was associated with higher levels of injury severity or with a higher likelihood of being fatally injured in the crash
• Illicitdrugswereusedmorebyyoungerpeoplewhilemedicationusewasmorecommonamong older road users
• Males were over-represented among fatalities and serious injuries
• Substance use was associated with single vehicle crashes, especially those that involved striking a fixed roadside object.
The literature review included sections on trauma related to road crashes as well as on trauma in general but chiefly focused on specific injury types relevant to the Lifetime Support Authority (LSA): traumatic brain injury (TBI), spinal cord injury (SCI), burns and amputations. Although different injury types are associated with their own specific issues (see Sections 4.7.2 to 4.7.5), some general findings also emerged from the review:
• Traumatic injuries frequently occur when people are impaired by substances. Substance use at the time of the injury is linked to worse outcomes.
• Following serious injury, substance use tends to decline initially, often due to the functional incapacity of the patient, but typically reverts to pre-injury usage levels once the patient has recovered from the acute phase of the injury. Post-injury substance use is often linked to worse outcomes.
• Traumatic injury is often associated with chronic pain and mental health conditions. Substance use, either licit or illicit, is often related to these issues.
• Opioids are frequently prescribed to treat chronic pain. Opioids pose the risk of various negative outcomes. Alternative therapies should be sought where possible.
• Similarly, many traumatic injuries represent complex problems for which a number of different medications are prescribed. Care is needed to avoid the dangers of polypharmacy among patients in this situation.
Although the literature provides a wealth of information in relation to substance use after various types of traumatic injury, there are limitations to which the findings may be generalisable to LSS participants. This notwithstanding, it is clear that post-injury substance use often replicates pre-injury use and, given that seriously injured road users exhibit high rates of substance use and that there are clear risks identified in the literature from post-injury substance use, a study of post-injury substance use among a sample of seriously injured road users in South Australia would be beneficial to examine this issue in a local context. Ideally, such a study would be based on interviews with the LSS participants themselves, with findings compared to the risks identified in the literature. However, it is understood that such a study may not be possible. Other potential methodologies to investigate post-injury substance use have been proposed, based on interviewing crash participants from CASR’s in-depth crash investigation program, or interviewing injured road users admitted to the RAH. The latter is likely to provide a greater likelihood of recruiting a sufficiently large sample. |