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Long-Term Prescription Opioid Use After Injury in Washington State 2015–2018

  • Vivian H. Lyons
    Correspondence
    Reprint Address: Vivian H. Lyons, PhD, MPH, Social Development Research Group, UW Box#3587349725, Third Ave NE, Suite #401Seattle WA 98115.
    Affiliations
    Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan

    Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, School of Public Health, University of Washington, Seattle, Washington
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  • Miriam J. Haviland
    Affiliations
    Harborview Injury Prevention & Research Center, School of Public Health, University of Washington, Seattle, Washington
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  • Irene Y. Zhang
    Affiliations
    Department of Surgery, School of Public Health, University of Washington, Seattle, Washington

    Surgical Outcomes Research Center, School of Public Health, University of Washington, Seattle, Washington
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  • Lauren K. Whiteside
    Affiliations
    Department of Emergency Medicine, School of Public Health, University of Washington, Seattle, Washington
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  • Saman Arbabi
    Affiliations
    Department of Surgery, School of Public Health, University of Washington, Seattle, Washington
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  • Monica S. Vavilala
    Affiliations
    Harborview Injury Prevention & Research Center, School of Public Health, University of Washington, Seattle, Washington

    Department of Anesthesiology and Pain Medicine, School of Public Health, University of Washington, Seattle, Washington
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  • Michele Curatolo
    Affiliations
    Harborview Injury Prevention & Research Center, School of Public Health, University of Washington, Seattle, Washington

    Department of Anesthesiology and Pain Medicine, School of Public Health, University of Washington, Seattle, Washington
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  • Frederick P. Rivara
    Affiliations
    Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, School of Public Health, University of Washington, Seattle, Washington

    Harborview Injury Prevention & Research Center, School of Public Health, University of Washington, Seattle, Washington

    Department of Pediatrics, School of Public Health, University of Washington, Seattle, Washington

    Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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  • Ali Rowhani-Rahbar
    Affiliations
    Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, School of Public Health, University of Washington, Seattle, Washington

    Department of Pediatrics, School of Public Health, University of Washington, Seattle, Washington

    Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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      Abstract

      Background

      Patients with injury may be at high risk of long-term opioid use due to the specific features of injury (e.g., injury severity), as well as patient, treatment, and provider characteristics that may influence their injury-related pain management.

      Objectives

      Inform prescribing practices and identify high-risk populations through studying chronic prescription opioid use in the trauma population.

      Methods

      Using the Washington State All-Payer Claims Database (WA-APCD) data, we included adults aged 18–65 years with an incident injury from October 1, 2015–December 31, 2017. We compared patient, injury, treatment, and provider characteristics by whether or not the patients had long-term (≥ 90 days continuous prescription opioid use), or no opioid use after injury.

      Results

      We identified 191,130 patients who met eligibility criteria and were included in our cohort; 5822 met criteria for long-term use. Most had minor injuries, with a median Injury Severity Score = 1, with no difference between groups. Almost all patients with long-term opioid use had filled an opioid prescription in the year prior to their injury (95.3%), vs. 31.3% in the no-use group (p < 0.001). Comorbidities associated with chronic pain, mental health, and substance use conditions were more common in the long-term than the no-use group.

      Conclusion

      Across this large cohort of multiple, mostly minor, injury types, long-term opioid use was relatively uncommon, but almost all patients with chronic use post injury had preinjury opioid use. Long-term opioid use after injury may be more closely tied to preinjury chronic pain and pain management than acute care pain management.

      Keywords

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