Citation

Field CA, Cochran G, Caetano R, Foreman M, Brown CV. J. Trauma Acute Care Surg. 2014; 76(3): 833-839.

Affiliation

From the University of Texas at Austin (C.A.F.); and University Medical Center at Brackenridge (C.V.R.B.), Austin; and University of Texas School of Public Health and University of Texas Southwestern Medical Center (R.C.); and Baylor University Medical Center (M.F.), Dallas, Texas; University of Pittsburgh (G.C.), Pittsburgh, Pennsylvania.

Copyright

(Copyright © 2014, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000100

PMID

24553557

Abstract

BACKGROUND: Nonmedical use of prescription opioids (NM-POs) has reached epidemic proportions in the United States. Unintentional overdose deaths involving prescription opioids have quadrupled since 1999. Herein, we examine NM-POs and their associated risk factors among two cohorts of trauma patients with at-risk drinking. METHODS: This secondary analysis examines NM-PO from two separate randomized trials that delivered brief alcohol interventions to patients in urban Level I trauma centers. In the first study, data were collected from 1,493 injured patients at a single trauma center, and in the second study, data were collected from 596 injured patients at two trauma centers. All participants were considered at-risk drinkers because they were admitted for an alcohol related injury as indicated by a positive blood alcohol concentration and/or self-reported heavy drinking. RESULTS: In Study 1, NM-PO nearly doubled from 5.2% before admission to 9.8% at 6 months after discharge. At 12 months after discharge, those who reported NM-PO (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.28-4.15) and drug use (OR, 2.62, 95% CI, 1.70-4.04) before admission had the highest odds for postdischarge NM-PO. In Study 2, NM-PO increased from 5.2% before admission to 6.8% at 12 months after discharge. At 12 months after discharge, those who reported NM-PO (OR, 2.71; 95% CI, 1.10-6.66) or drug use (OR, 4.05; 95% CI, 2.00-8.21) before admission had the highest odds for postdischarge NM-PO. CONCLUSION: The results suggest that there is an increased risk of postdischarge NM-PO among injured patients with at-risk drinking, particularly among those with a recent history of drug use or NM-PO. Cautious, evidence-based opioid prescribing may reduce exposure to prescription opioids in high-risk patients, risk of subsequent misuse, and possible diversion. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level II.

Language: en