Opioid Use Within a Year Following Discharge in Trauma Patients With Prior Opioid Use Disorder

Patients with opioid use disorder (OUD) are more susceptible to traumatic injuries, with OUD present in approximately 1% of operative trauma cases. The perioperative period for these patients necessitates balancing pain management with relapse risk. This study evaluates the addiction consult service (ACS) and management of medications for OUD (MOUD) during and posthospitalization to identify associations with reduced rates of opioid use within a year (OUWY) following discharge.

A retrospective cohort study identified trauma patients with documented OUD admitted to a level 1 trauma center from January 1, 2017 to December 31, 2022. Patients were stratified by postdischarge OUWY status, with OUWY defined as any nonprescribed (illegal and/or nonprescribed prescription) opioid use. Chi-squared, Fischer exact, and Kruskal-Wallis analyses were conducted. Two modified Poisson models estimated relative risk of OUWY, examining associations with MOUD, either at admission or discharge, and the ACS.

Among 211 patients with known OUWY status, the OUWY rate was 61%. Patients discharged on MOUD had a 34% lower OUWY risk (relative risk = 0.66, 95% confidence interval [0.50-0.89], P = 0.005). Discharge on methadone was associated with a higher OUWY rate compared to buprenorphine-naloxone (83% versus 50%, P < 0.0001). Admission on MOUD and ACS consult were not associated with a lower risk of OUWY.

Discharge on MOUD, particularly buprenorphine-naloxone, may reduce OUWY risk in trauma patients with OUD. Ensuring continuation or initiation of MOUD during hospitalization may be an effective strategy to reduce OUWY, and the role the ACS plays in that process cannot be discounted, despite this study's inconclusive findings regarding the ACS.