Jannette Baird1, Mark Faul2, Traci C Green3, Jonathan Howland3, Charles A Adams4, Ann George5, Michael J Mello6. 1. Warren Alpert School of Medicine at Brown University, United States. Electronic address: jbaird@lifespan.org. 2. Centers for Disease Control and Prevention, United States. 3. Warren Alpert School of Medicine at Brown University, United States; Boston University School of Medicine, United States. 4. Rhode Island Hospital, Division of Trauma and Surgical Critical Care, United States. 5. University Surgical Associates, United States. 6. Warren Alpert School of Medicine at Brown University, United States; Brown University School of Public Health, United States.
Abstract
BACKGROUND: Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primary purpose of this study was to assess the prevalence of substance use and unintentional opioid overdose risk among acutely injured trauma patients, and to examine the frequency and predictors of high opioid dose at discharge. METHODS: A retrospective electronic medical record (EMR) review of three-months of data from two Level 1 trauma centers. We assessed the prevalence of substance misuse, unintentional opioid overdose risk, and presence of documentation of clinical strategies to mitigate these risks, such as co-prescription of the opioid agonist naloxone. RESULTS: In total, 352 patient EMRs were examined. Over 40% of the patients reviewed had at least one indication of substance misuse (42.5% [95%CI: 37.3, 47.7]); at least 1 unintentional opioid overdose risk factor was identified in 240 EMR reviewed (68.2% [95%CI: 63.3, 73.1]). Dose of opioid medication was not significantly different for patients with substance misuse versus those without. There was no co-prescription of naloxone for any of the discharged patients. CONCLUSIONS: Our results indicate that despite the high rates of substance misuse, the potential for misuse, dependence and unintentional overdose risk from prescribed opioid medications are prevalent among acutely injured trauma patients. Prescribing after acute trauma care should address these risk factors.
BACKGROUND: Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primary purpose of this study was to assess the prevalence of substance use and unintentional opioid overdose risk among acutely injured traumapatients, and to examine the frequency and predictors of high opioid dose at discharge. METHODS: A retrospective electronic medical record (EMR) review of three-months of data from two Level 1 trauma centers. We assessed the prevalence of substance misuse, unintentional opioid overdose risk, and presence of documentation of clinical strategies to mitigate these risks, such as co-prescription of the opioid agonist naloxone. RESULTS: In total, 352 patient EMRs were examined. Over 40% of the patients reviewed had at least one indication of substance misuse (42.5% [95%CI: 37.3, 47.7]); at least 1 unintentional opioid overdose risk factor was identified in 240 EMR reviewed (68.2% [95%CI: 63.3, 73.1]). Dose of opioid medication was not significantly different for patients with substance misuse versus those without. There was no co-prescription of naloxone for any of the discharged patients. CONCLUSIONS: Our results indicate that despite the high rates of substance misuse, the potential for misuse, dependence and unintentional overdose risk from prescribed opioid medications are prevalent among acutely injured traumapatients. Prescribing after acute trauma care should address these risk factors.
Authors: Lynn R Webster; Susan Cochella; Nabarun Dasgupta; Keri L Fakata; Perry G Fine; Scott M Fishman; Todd Grey; Erin M Johnson; Lewis K Lee; Steven D Passik; John Peppin; Christina A Porucznik; Albert Ray; Sidney H Schnoll; Richard L Stieg; Wayne Wakeland Journal: Pain Med Date: 2011-06 Impact factor: 3.750
Authors: Craig A Field; Gerald Cochran; Raul Caetano; Michael Foreman; Carlos V R Brown Journal: J Trauma Acute Care Surg Date: 2014-03 Impact factor: 3.313
Authors: Janette Baird; Mark Faul; Traci C Green; Jonathan Howland; Charles A Adams; Melinda J Hodne; Nie Bohlen; Michael J Mello Journal: J Trauma Nurs Date: 2019 May/Jun Impact factor: 1.010
Authors: Traci C Green; Corey Davis; Ziming Xuan; Alexander Y Walley; Jeffrey Bratberg Journal: Am J Public Health Date: 2020-04-16 Impact factor: 9.308