PLoS ONE (Jan 2022)

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

  • 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

DOI
https://doi.org/10.1371/journal.pone.0273378
Journal volume & issue
Vol. 17, no. 9
p. e0273378

Abstract

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ObjectiveWhether 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.MethodsParticipants 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.ResultsOf 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).ConclusionsED 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.