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Prolonged opioid use in trauma patients: A multicenter cohort study
Wardah Rafaqat1, Matthew K Simpson, Ikemsinachi C Nzenwa
1Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery (W.R., M.K.S., I.C.N., Y.A., V.S.P., J.O.H.), Massachusetts General Hospital, Harvard Medical School; Center for Surgery and Public Health (S.I., G.A.A., J.H.E.), Brigham and Women's Hospital; Division of Trauma, Department of Surgery (S.E.S.), Boston Medical Center, Boston, Massachusetts; and the Department of Health Law, Policy & Management (J.H.E.), Boston University School of Public Health.
Background:
Trauma patients are vulnerable to long-term prescription opioid use (LTPOU) because of high prevalence of postinjury pain, but risk factors of self-reported LTPOU remain understudied in this population. Therefore, we aimed to understand the predictors of LTPOU in the trauma population and the long-term functional outcomes associated with it.
Methods:
We conducted a retrospective cohort study, including patients 18 years or older with an Injury Severity Score of ≥9, who were admitted between July 2022 and December 2023 at one of three Level I trauma centers in our region. Patients were contacted between 6 and 12 months postinjury and administered a trauma quality of life survey. Long-term prescription opioid use was defined as having used prescription opioids within 3 months of participating in the survey. Adjusting for patient and injury characteristics, predictors of LTPOU were identified using stepwise logistic regression.
Results:
We included 809 patients, of whom 127 (15.7%) reported LTPOU. In our adjusted analysis, comorbid conditions, work-related injuries, Medicaid insurance, low education level, prior mental health disorders, and polytrauma were predictors of LTPOU, and severe head injury was protective. In a subgroup analysis of patients who did not experience chronic pain, young age, low education level, comorbid conditions, and polytrauma were predictors of LTPOU. Assessment of longer-term outcomes revealed that LTPOU was associated with posttraumatic stress disorder, new financial hardship, and new functional limitations in patients both with and without chronic pain.
Conclusion:
Approximately, 16% of trauma patients reported LTPOU, and prior mental health disorders, low education levels, Medicaid insurance, comorbid conditions, and polytraumatic and work-related injuries were predictors of LTPOU. In patients without chronic pain, young age, low education levels, polytrauma, and comorbid conditions were predictors. ( J Trauma Acute Care Surg . 2026;100: 804-809. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
Level Of Evidence:
Therapeutic/Care Management; Level III.
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