Acute pain: preinjury opioid abuse tied to 40% higher consumption

  • Salottolo K & al.
  • Injury
  • 8 Jan 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients who tested positive for drugs after a vehicle trauma consumed 40% more opioids for acute pain than those who tested negative.
  • One-third of accident patients tested positive for drugs or alcohol.

Why this matters

  • Patients who test positive for substances may require a special acute pain management strategy.

Study design

  • Retrospective multi-institutional study evaluated 176 patients with vehicular trauma who were admitted to 4 level 1 trauma centers over the course of 4 months.
  • Effect of positive urine drug screen (UDS) and positive blood alcohol content (BAC; ≥80 mg/dL) on pain management with opioid analgesics over the hospital stay was examined.
  • Funding: Swedish Medical Center; St. Anthony Hospital.

Key results

  • A positive drug/alcohol finding was reported in 33.5% of patients, including 12.5% and 26% with a positive UDS and BAC, respectively.
  • Patients with positive vs negative UDS had significantly greater opioid consumption (34.7 vs 24.7 mg morphine equivalents; P=.04), corresponding to a 1.4-fold increased consumption of opioids for acute pain management.
  • After adjustment, average daily pain scores were similar irrespective of UDS and BAC findings (P=.76).

Limitations

  • Study only 60% powered to detect the observed differences.
  • Patients may be misclassified as substance users and nonsubstance users.

Coauthored with Antara Ghosh, PhD