Effects of Opioid Use Duration on Complications and Healthcare Utilization and Costs in Spinal Cord Injury

Chronic pain management with opioids after spinal cord injury (SCI) has been shown to be ineffective, leading to overuse in length and dosage.

To assess how the length of opioid use affects associated complications and healthcare usage and costs over 12 months following injury.

Adults with SCI from MarketScan Database (2000-2021) were followed up 12 months pre- and post-injury. Opioid use (OU) was screened from injury. Individuals were then classified accordingly: no use (No OU), 3 months use (OU 3m), 3 to 6 months use (OU 3-6m), and 6 to 12 months use (OU 6-12m). Related complications, healthcare utilization, and payment outcomes were compared using multivariable generalized linear regressions.

Cohort was composed of 9630 individuals (median age 54; 59% males). Prolonged-use group (OU 6-12m) had a different profile compared to the No OU group: younger, higher rates of males, bone fracture, thoracic injuries, and Medicaid insurance (median age 49 vs. 58; males 62% vs. 56%, fracture 58% vs. 50%, thoracic 29% vs. 21%, Medicaid 32% vs. 24%; all Ps < .0001). A year after SCI, opioid-related complications were constipation, respiratory depression, hypotension, urinary retention, and nausea/vomiting, with an associated cost 2.4 times higher in OU 6-12m compared to No OU ($6958 vs. $2842). Opioid users (>3 months) had more ER visits and higher hospitalization rates compared to No OU. Combined payments (ER, hospitalizations, PT/OT/SLT, outpatient services, and medication refills) were higher for OU 6-12 ($33,014) and OU 3-6m ($22,351) compared to No OU ($13,896; P < .0001).

Considering risk profiles may predict prolonged opioid use and could help clinicians design care management plans to reduce complications and the associated healthcare utilization and payments.