Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients
Received 7 March 2020
Accepted for publication 9 May 2020
Published 27 May 2020 Volume 2020:15 Pages 763—770
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Raoul Daoust,1,2 Jean Paquet,1 Lynne Moore,3,4 Alexis Cournoyer,1,2 Marcel Émond,5 Sophie Gosselin,6,7 Gilles J Lavigne,8,9 Aline Boulanger,10,11 Jean-Marc Mac-Thiong,2,12 Jean-Marc Chauny1,2
1Centre d’Étude en Médecine d’Urgence, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada; 2Département Médecine Familiale et Médecine d’Urgence, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada; 3Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec, Quebec, Canada; 4Axe de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQS du CHU-Québec, Quebec, Quebec, Canada; 5Département de médecine familiale et de médecine d’urgence, Faculté DE médecine, Université Laval, Quebec, Quebec, Canada; 6Department of Emergency Medicine, McGill University Health Centre, McGill University, Montréal, Quebec, Canada; 7Département de médecine d’urgence, CISSS-Montérégie-Centre, Greenfield Park, Québec, Canada; 8Faculties of Dental Medicine and Medicine, Université de Montréal, Montréal, Quebec, Canada; 9Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l’Île-de-Montréal), Montréal, Quebec, Canada; 10Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Quebec, Canada; 11Département d’anesthésiologie, Faculté de médecine, Université de Montréal, Montréal, Quebec, Canada; 12Research Centre, Hôpital du Sacré-Coeur (CIUSSS du Nord de-l’île-de-Montréal), Montréal, Quebec, Canada
Correspondence: Raoul Daoust Email email@example.com
Background: Patients hospitalized following a traumatic injury will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (< 3 months) opioid use after discharge and the risk of opioid poisoning or use disorder in older trauma patients.
Methods: In a retrospective multicenter cohort study conducted on registry data, we included all patients ≥ 65 years admitted (hospital stay > 2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for opioid poisoning and opioid use disorder from ICD-9 to ICD-10 code diagnosis after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not, using Cox proportional hazards regressions.
Results: A total of 70,314 admissions were retained for analysis; median age was 82 years (IQR: 75– 87), 68% were women, and 34% of the patients filled an opioid prescription within 3 months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1– 5), 192 participants (0.27%; 95% CI: 0.23%-0.31%) were hospitalized for opioid poisoning and 73 (0.10%; 95% CI: 0.08%-0.13%) were diagnosed with opioid use disorder. Having filled an opioid prescription within 3 months of injury was associated with an increased hazard ratio of opioid poisoning (2.8; 95% CI: 2.1– 3.8) and opioid use disorder (4.2; 95% CI: 2.4– 7.4) after the injury. However, history of opioid poisoning (2.6; 95% CI: 1.1– 5.8), of substance use disorder (4.3; 95% CI: 2.4– 7.7), or of the opioid prescription filled (2.8; 95% CI: 2.2– 3.6) before the trauma, was also related to opioid poisoning or opioid use disorder after the injury.
Conclusion: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with a history of substance use disorder, opioid poisoning or opioid use.
Keywords: prescription opioids, opioid poisoning, opioid use disorder, trauma, injury, older adults
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]