Preinjury opioid use may predict addictive behavior

Study Examines Opiate Use in Orthopedic Trauma Patients
Study Examines Opiate Use in Orthopedic Trauma Patients

HealthDay News -- Orthopedic trauma patients were almost twice as likely to use prescription opioids prior to injury than the general population, a behavior that may indicate prolonged opiate use and opiate seeking behavior, study findings show.

In the three months prior to injury, 15.5% of orthopedic trauma patients had filled a prescription for opiates compared with 9.2% of the general population (P<0.001).

These patients were six times more likely to continue opiate use past 12 weeks and 3.5 times more likely to obtain opiates from a provider other than their surgeon (P<0.001), Joel E. Holman, MD, of the University of Utah in Salt Lake City and colleagues reported in the Journal of Bone & Joint Surgery.

Mortality from prescription opioid overdose has reached epidemic proportions in the United States, and is now the leading cause of accidental death in more than half of all 50 states. 

"The prudent use of prescription opiate medications is a central aspect of postoperative pain management," the researchers noted.

To determine risk factors for prolonged opioid use post injury, Holman and colleagues queried the Utah Controlled Substance Database to examine usage of prescription opiates three months prior to injury and six months post-injury among 613 patients admitted to the orthopedic trauma service with isolated musculoskeletal injuries.

Significantly more trauma patients filled more than one prescription pre-injury versus the general population (12.2% vs. 6.4%; P<0.001), the researchers found. The proportion of patients who filled prescriptions for opioids more than 12 weeks after surgery was 19.7%, compared with 68.4% in the first six weeks and 11.9% in the six to 12 week post-surgery period.

Preinjury opioid use correlated with a six-fold increase in the likelihood of opioid use past 12 weeks post operation, and with a 3.5-fold increased likelihood of obtaining opiates from a provider other than the surgeon. Advancing age and extent of pre-injury use were other risk factors for prolonged opiate use on regression models.

Opiate use was briefest with upper-extremity injuries, followed by lower-extremity injuries and pelvic or acetabular injuries. 

"Pre-injury opiate use is predictive of prolonged use post-injury and predictive of patients who will seek opiates from other providers," the researchers concluded.

References

  1. Holman JE et al. J Bone Joint Surg Am. 2013;95(12):1075-1080.
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