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

Area of Science:

• Trauma Surgery
• Addiction Medicine
• Pharmacology

Background:

• Patients with opioid use disorder (OUD) face higher risks of traumatic injuries and require careful perioperative pain management to mitigate relapse.
• OUD affects approximately 1% of patients in operative trauma cases, highlighting a critical need for specialized care.

Purpose of the Study:

• To evaluate the impact of addiction consult services (ACS) and medication for opioid use disorder (MOUD) management on reducing opioid use within a year (OUWY) after hospital discharge.
• To identify optimal MOUD strategies for trauma patients with OUD during and after hospitalization.

Main Methods:

• A retrospective cohort study analyzed 211 trauma patients with OUD admitted to a level 1 trauma center between 2017 and 2022.
• Patients were categorized by post-discharge OUWY status (defined as any nonprescribed opioid use).
• Modified Poisson models assessed the relative risk of OUWY in association with MOUD at admission/discharge and ACS consults.

Main Results:

• The overall OUWY rate was 61% among the studied patients.
• Discharge on MOUD was associated with a 34% reduction in OUWY risk (RR=0.66, P=0.005).
• Discharge on buprenorphine-naloxone showed a lower OUWY rate (50%) compared to methadone (83%). Admission MOUD and ACS consults did not significantly reduce OUWY risk.

Conclusions:

• Discharging trauma patients with OUD on MOUD, particularly buprenorphine-naloxone, is a promising strategy to decrease long-term opioid use.
• Ensuring MOUD continuity or initiation during hospitalization is crucial for reducing post-discharge opioid use.
• While this study's findings on ACS were inconclusive, their role in facilitating MOUD management warrants further investigation.