Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study

• Type of Material: Article
• Authors: Brittany E Punches, The Ohio State University; Uwe Stolz, University of Cincinnati; Caroline E Freiermuth, University of Cincinnati; Rachel M Ancona, Washington University School of Medicine in St. Louis; Samuel A McLean, The University of North Carolina at Chapel Hill; Stacey L House, Washington University School of Medicine in St. Louis; Francesca L Beaudoin, The Warren Alpert Medical School; Xinming An, The University of North Carolina at Chapel Hill; Jennifer Stevens, Emory University; Donglin Zeng, The University of North Carolina at Chapel Hill; Thomas C Neylan, University of California, San Francisco; Gari Clifford, Emory University; Tanja Jovanovic, Emory University; Sarah D Linnstaedt, The University of North Carolina at Chapel Hill; Laura T Germine, McLean Hospital; Kenneth A Bollen, The University of North Carolina at Chapel Hill; Scott L Rauch, McLean Hospital; John P Haran, University of Massachusetts Chan Medical School; Alan B Storrow, Vanderbilt University Medical Center; Christopher Lewandowski, Henry Ford Health System; Paul I Musey, Indiana University School of Medicine; Phyllis L Hendry, University of Florida College of Medicine; Sophia Sheikh, University of Florida College of Medicine; Christopher W Jones, Cooper Medical School of Rowan University; Michael C Kurz, University of Alabama at Birmingham School of Medicine; Nina T Gentile, Lewis Katz School of Medicine; Meghan E McGrath, Boston Medical Center; Lauren Hudak, Emory University; Jose L Pascual, University of Pennsylvania; Mark J Seamon, University of Pennsylvania Perelman School of Medicine; Erica Harris, Einstein Healthcare Network; Anna M Chang, Jefferson University Hospitals; Claire Pearson, Wayne State University; David A Peak, Massachusetts General Hospital; Roland C Merchant, Brigham and Women's Hospital; Robert M Domeier, St. Joseph Mercy Hospital; Niels K Rathlev, University of Massachusetts Chan Medical School; Brian J O Neil, Wayne State University; Leon D Sanchez, Beth Israel Deaconess Medical Center; Steven E Bruce, University of Missouri-St. Louis; Robert H Pietrzak, VA Connecticut Healthcare System; Jutta Joormann, Yale School of Medicine; Deanna M Barch, Washington University in St. Louis; Diego A Pizzagalli, Harvard Medical School; Jordan W Smoller, Massachusetts General Hospital; Beatriz Luna, University of Pittsburgh School of Medicine; Steven E Harte, University of Michigan Medical School; James M Elliott, Kolling Institute of Medical Research; Ronald C Kessler, Harvard Medical School; Kerry Ressler, Emory University; Karestan C Koenen, Harvard T.H. Chan School of Public Health; Michael S Lyons, University of Cincinnati
• Language: English
• Date: 2022-09-01
• Publisher: PLoS ONE
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Punches et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0273378
• Title of Journal or Parent Work: PLoS ONE
• Volume: 17
• Issue: 9 September
• Start Page: e0273378
• End Page: e0273378
• Grant/Funding Information: This manuscript was in part funded by NIDA K08 DA049948. The parent study from which data was obtained for this analysis was funded by NIMH U01MH110925, the US Army Medical Research and Material Command, The One Mind Foundation, and The Mayday Fund. Verily Life Sciences and Mindstrong Health provided hardware and software used to perform study assessments. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: Emergency Service, Hospital; Opioid-Related Disorders; Acute Pain; Analgesics, Opioid; Adult; Practice Patterns, Physicians'; Prospective Studies; Humans
• Research Categories: Health Sciences, Mental Health; Health Sciences, Nursing; Biology, Biostatistics; Health Sciences, Medicine and Surgery

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.