Outpatient Opioid Prescriptions are Associated with Future Substance use Disorders and Overdose Following Adolescent Trauma

Abstract

Objective: This study aims to determine if outpatient opioid prescriptions are associated with future substance use disorder (SUD) diagnoses and overdose in injured adolescents five years following hospital discharge.

Summary Background Data: Approximately, 1 in 8 adolescents are diagnosed with an SUD and 1 in 10 experience an overdose in the five years following injury. State laws have become more restrictive on opioid prescribing by acute care providers for treating pain, however, prescriptions from other outpatient providers are still often obtained.

Methods: This was a retrospective cohort study of patients ages 12–18 admitted to two level I trauma centers. Demographic and clinical data contained in trauma registries were linked to a regional database containing five years of electronic health records and prescription data. Regression models assessed whether number of outpatient opioid prescription fills after discharge at different time points in recovery were associated with a new SUD diagnosis or overdose, while controlling for demographic and injury characteristics, as well as depression and PTSD diagnoses.

Results: We linked 669 patients (90.9%) from trauma registries to a regional health information exchange database. Each prescription opioid refill in the first 3 months after discharge increased the likelihood of new SUD diagnoses by 55% (OR:1.55, CI:1.04–2.32). Odds of overdose increased with ongoing opioid use over 2–4 years post-discharge (p = 0.016–0.025).

Conclusions: Short-term outpatient opioid prescribing over the first few months of recovery had the largest effect on developing an SUD, while long-term prescription use over multiple years was associated with a future overdose.