Adverse Drug Events Associated with Opioid Treatment for Pain After Motor Vehicle Crash

Thousands of motor vehicle crash (MVC) related deaths and injuries occur among older adults every year in the United States. Injuries from MVC may cause acute or chronic pain resulting in functional decline and disability. Opioid treatment poses risk of adverse drug events (ADEs) including dependency, overdose, respiratory problems, and other complications. Our objective was to evaluate the comparative risks of ADEs associated with three opioid prescribing strategies: 1) greater versus lesser days' supply (≥6 days versus ≤5 days), 2) higher versus lower doses (≥30 MME versus <30 MME), and 3) tramadol versus other opioids over 45 days of follow-up.

The study utilized Medicare claims linked to New Jersey drivers' licensing and police-reported crashes to emulate three target trials for each pairwise treatment comparison from May 1, 2007-November 16, 2017. The study included Medicare beneficiaries aged >67 years who initiated opioids within 10 days after MVC.

Among 510 beneficiaries, the mean (standard deviation) age was 76.1 (6.6) years, with 59.8% females and 90.4% White race. For the intention-to-treat estimand, risk ratios (RRs) [95% confidence limits (CLs)] were 1.64 (0.64, 4.57), 0.83 (0.45, 1.76), and 0.54 (0.21, 4.01) for days' supply, dose, and tramadol treatment strategies, respectively. There were no significant differences in ADE risk for any of the pairwise treatment comparisons in the intention-to-treat or per-protocol analyses. However, there was a considerable amount of uncertainty surrounding our effect measures.

Physicians must continue to exercise caution while considering prescribing opioids for pain management in older adults.