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Persistent Opioid Use After Combat Injury and Subsequent Long-term Risk of Abuse : A Retrospective Cohort Study

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Objective:

To determine whether persistent opioid use after injury is associated with subsequent long-term development of clinically recognized opioid abuse. Summary Background Data:

Opioid abuse is an epidemic in the United States and trauma can initiate persistent use; however, it remains unclear whether persistent opioid use contributes to the subsequent development of opioid abuse. The care of combat casualties by the Departments of Defense and Veterans Affairs uniquely allows investigation of this long-term outcome.
Methods:

This retrospective cohort study randomly selected 10,000 battle-injured United States military personnel. We excluded patients who died during initial hospitalization or within 180 days of discharge, had a preinjury opioid abuse diagnosis, or had missing data in a preselected variable. We defined persistent opioid use as filling an opioid prescription 3 to 6 months after discharge and recorded clinically recognized opioid abuse using relevant diagnosis codes.
Results:

After exclusion, 9284 subjects were analyzed, 2167 (23.3%) of whom developed persistent opioid use. During a median follow-up time of 8 years, 631 (6.8%) patients developed clinically recognized opioid abuse with a median time to diagnosis of 3 years. Injury severity and discharge opioid prescription amount were associated with persistent opioid use after trauma. After adjusting for patient and injury-specific factors, persistent opioid use was associated with the long-term development of clinically recognized opioid abuse (adjusted hazard ratio, 2.39; 95% confidence interval, 1.99–2.86).
Conclusions:

Nearly a quarter of patients filled an opioid prescription 3 to 6 months after discharge, and this persistent use was associated with long-term development of opioid abuse.

Keywords: combat casualties; department of veterans affairs; injury; long-term risk; military health; opiate; opioid; trauma

Document Type: Research Article

Affiliations: 1: University of California Davis Medical Center, Sacramento, CA, David Grant USAF Medical Center, Travis Air Force Base, CA 2: David Grant USAF Medical Center, Travis Air Force Base, CA 3: VA Salt Lake City Health Care System, Salt Lake City, UT, University of Utah School of Medicine, Salt Lake City, UT 4: University of Utah School of Medicine, Salt Lake City, UT 5: Defense Health Agency, Falls Church, VA 6: Leidos Inc., San Diego, CA 7: University of Texas at San Antonio, San Antonio, TX 8: Joint Trauma System, Joint Base San Antonio, TX 9: David Grant USAF Medical Center, Travis Air Force Base, CA, Uniformed Services University of Health Sciences, Bethesda, MD.

Publication date: December 15, 2021

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