Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study
Authors
Punches, Brittany EStolz, Uwe
Freiermuth, Caroline E
Ancona, Rachel M
McLean, Samuel A
House, Stacey L
Beaudoin, Francesca L
An, Xinming
Stevens, Jennifer S
Zeng, Donglin
Neylan, Thomas C
Clifford, Gari D
Jovanovic, Tanja
Linnstaedt, Sarah D
Germine, Laura T
Bollen, Kenneth A
Rauch, Scott L
Haran, John P
Storrow, Alan B
Lewandowski, Christopher
Musey, Paul I
Hendry, Phyllis L
Sheikh, Sophia
Jones, Christopher W
Kurz, Michael C
Gentile, Nina T
McGrath, Meghan E
Hudak, Lauren A
Pascual, Jose L
Seamon, Mark J
Harris, Erica
Chang, Anna M
Pearson, Claire
Peak, David A
Merchant, Roland C
Domeier, Robert M
Rathlev, Niels K
O'Neil, Brian J
Sanchez, Leon D
Bruce, Steven E
Pietrzak, Robert H
Joormann, Jutta
Barch, Deanna M
Pizzagalli, Diego A
Smoller, Jordan W
Luna, Beatriz
Harte, Steven E
Elliott, James M
Kessler, Ronald C
Ressler, Kerry J
Koenen, Karestan C
Lyons, Michael S
UMass Chan Affiliations
Emergency MedicineDocument Type
Journal ArticlePublication Date
2022-09-23Keywords
OpioidsCritical care and emergency medicine
Pain
Traumatic injury
Analgesics
Aurora
Medical risk factors
Patients
Metadata
Show full item recordAbstract
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.Source
Punches BE, Stolz U, Freiermuth CE, Ancona RM, McLean SA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI Jr, Hendry PL, Sheikh S, Jones CW, Kurz MC, Gentile NT, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Smoller JW, Luna B, Harte SE, Elliott JM, Kessler RC, Ressler KJ, Koenen KC, Lyons MS. Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study. PLoS One. 2022 Sep 23;17(9):e0273378. doi: 10.1371/journal.pone.0273378. PMID: 36149896; PMCID: PMC9506640.DOI
10.1371/journal.pone.0273378Permanent Link to this Item
http://hdl.handle.net/20.500.14038/51475PubMed ID
36149896Rights
Copyright: © 2022 Punches et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.; Attribution 4.0 InternationalDistribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.1371/journal.pone.0273378
Scopus Count
Collections
The following license files are associated with this item:
- Creative Commons
Except where otherwise noted, this item's license is described as Copyright: © 2022 Punches et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.; Attribution 4.0 International