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

Authors :
Brittany E. Punches
Uwe Stolz
Caroline E. Freiermuth
Rachel M. Ancona
Samuel A. McLean
Stacey L. House
Francesca L. Beaudoin
Xinming An
Jennifer S. Stevens
Donglin Zeng
Thomas C. Neylan
Gari D. Clifford
Tanja Jovanovic
Sarah D. Linnstaedt
Laura T. Germine
Kenneth A. Bollen
Scott L. Rauch
John P. Haran
Alan B. Storrow
Christopher Lewandowski
Paul I. Musey
Phyllis L. Hendry
Sophia Sheikh
Christopher W. Jones
Michael C. Kurz
Nina T. Gentile
Meghan E. McGrath
Lauren A. Hudak
Jose L. Pascual
Mark J. Seamon
Erica Harris
Anna M. Chang
Claire Pearson
David A. Peak
Roland C. Merchant
Robert M. Domeier
Niels K. Rathlev
Brian J. O’Neil
Leon D. Sanchez
Steven E. Bruce
Robert H. Pietrzak
Jutta Joormann
Deanna M. Barch
Diego A. Pizzagalli
Jordan W. Smoller
Beatriz Luna
Steven E. Harte
James M. Elliott
Ronald C. Kessler
Kerry J. Ressler
Karestan C. Koenen
Michael S. Lyons
Publication Year :
2022
Publisher :
The University of North Carolina at Chapel Hill University Libraries, 2022.

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.

Details

Language :
English
Database :
OpenAIRE
Accession number :
edsair.doi.dedup.....3b108171dcd1f71b4f20000a038c34a9
Full Text :
https://doi.org/10.17615/4tzj-r085